Individual
DR. SHINE JOHN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DPM
Contact information
Practice address
11614 FM 2244 RD STE 150, AUSTIN, TX 78738-5471
(512) 399-5711
(512) 399-5707
Mailing address
11614 FM 2244 RD STE 150, AUSTIN, TX 78738-5471
(512) 399-5711
(512) 399-5707
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
016005365
IL
213E00000X
Podiatrist
1910
TX
213ES0103X
Foot & Ankle Surgery Podiatrist
Primary
1910
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
016005365
IL STATE LICENSE
IL
01
—
1910
STATE OF TEXAS
TX
Enumeration date
05/09/2008
Last updated
08/16/2022
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