Individual
SHELLY M HARVEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
600 S MAIN ST, FORT WORTH, TX 76104
(817) 882-2400
Mailing address
PO BOX 845347, DALLAS, TX 75284-7208
(817) 882-2400
(972) 566-8837
Taxonomy
Speciality
Code
Description
License number
State
207K00000X
Allergy & Immunology Physician
Primary
L4428
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1582256-01
—
TX
05
—
1741256
—
LA
05
—
200032380A
—
OK
01
—
8A9171
BCBS
—
Enumeration date
09/02/2005
Last updated
05/30/2019
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