Provider Demographics
NPI:1770874240
Name:SHAUN A MCMURTRY MD PLLC
Entity type:Organization
Organization Name:SHAUN A MCMURTRY MD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SHAUN
Authorized Official - Middle Name:
Authorized Official - Last Name:MCMURTRY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:214-934-2330
Mailing Address - Street 1:2303 IRA E WOODS AVE
Mailing Address - Street 2:
Mailing Address - City:GRAPEVINE
Mailing Address - State:TX
Mailing Address - Zip Code:76051-3926
Mailing Address - Country:US
Mailing Address - Phone:817-416-1016
Mailing Address - Fax:817-416-1019
Practice Address - Street 1:2303 IRA E WOODS AVE
Practice Address - Street 2:
Practice Address - City:GRAPEVINE
Practice Address - State:TX
Practice Address - Zip Code:76051-3926
Practice Address - Country:US
Practice Address - Phone:817-416-1016
Practice Address - Fax:817-416-1019
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-02
Last Update Date:2011-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN0265207QS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports MedicineGroup - Single Specialty