Provider Demographics
NPI:1396874483
Name:HOUSTON, SHIRLEY ANN (MD)
Entity type:Individual
Prefix:DR
First Name:SHIRLEY
Middle Name:ANN
Last Name:HOUSTON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5725 LAURIUM RD
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28226-5613
Mailing Address - Country:US
Mailing Address - Phone:704-364-6725
Mailing Address - Fax:
Practice Address - Street 1:7221 PINEVILLE MATTHEWS RD
Practice Address - Street 2:SUITE 200
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28226-6175
Practice Address - Country:US
Practice Address - Phone:704-264-1402
Practice Address - Fax:704-264-1403
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC33679207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCE55725Medicare UPIN