Individual
DR. PRESTON WAYNE SHUMWAY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
800 E DAWSON ST, TYLER, TX 75701-2036
(903) 531-5000
Mailing address
PO BOX 841656, DALLAS, TX 75284-1656
(903) 531-5000
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
5101018171
MI
207P00000X
Emergency Medicine Physician
Primary
P1407
TX
390200000X
Student in an Organized Health Care Education/Training Program
5101018171
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
304874601
—
TX
05
—
304874602
—
TX
05
—
304874603
—
TX
05
—
304874604
—
TX
01
—
75-2616977-001
TRICARE
TX
01
—
75-2616977-002
TRICARE
TX
01
—
75-2616977-028
TRICARE
TX
01
—
750818167015
TRICARE
TX
01
—
750818167022
TRICARE
TX
01
—
750818167044
TRICARE
TX
01
—
750818167048
TRICARE
TX
01
—
751976930005
TRICARE
TX
01
—
751976930022
TRICARE
TX
01
—
8DD750
BCBS
TX
01
—
8DD753
BCBS
TX
01
—
8DU721
BCBS
TX
01
—
8X8166
BCBS
TX
01
—
P01081147
RAIL ROAD
TX
01
—
P01081613
RAIL ROAD
TX
01
—
P01304487
RAIL ROAD
TX
Enumeration date
06/03/2009
Last updated
10/14/2014
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