Individual
JAY RYAN SHOBE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
12222 MERIT DR STE 600, DALLAS, TX 75251-3294
(972) 715-5000
(972) 715-9976
Mailing address
PO BOX 840853, DALLAS, TX 75284-0853
(972) 233-1999
(972) 233-3666
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
716616
TX
367500000X
Certified Registered Nurse Anesthetist
Primary
AP119853
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
220129501
—
TX
01
—
220129502
MEDICAID CSHCN
TX
01
—
8970UA
BCBS
TX
01
—
P00928950
RAILROAD MEDICARE
TX
Enumeration date
12/29/2010
Last updated
11/28/2022
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