Provider Demographics
NPI:1669580957
Name:AUVENSHINE, MICHAEL SCOTT (MD)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:SCOTT
Last Name:AUVENSHINE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26635 US HIGHWAY 380 E
Mailing Address - Street 2:
Mailing Address - City:AUBREY
Mailing Address - State:TX
Mailing Address - Zip Code:76227
Mailing Address - Country:US
Mailing Address - Phone:940-365-9389
Mailing Address - Fax:940-365-9128
Practice Address - Street 1:26635 US HIGHWAY 380 E
Practice Address - Street 2:
Practice Address - City:AUBREY
Practice Address - State:TX
Practice Address - Zip Code:76227
Practice Address - Country:US
Practice Address - Phone:940-365-9389
Practice Address - Fax:940-365-9128
Is Sole Proprietor?:No
Enumeration Date:2006-08-27
Last Update Date:2024-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL7971207QS0010X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX185816901Medicaid
TX185816902OtherMEDICAID OTHER
TXP00438002OtherRAILROAD MEDICARE
TX185816901Medicaid
TX8G8622Medicare PIN