Individual
KEVIN D. SHOULTS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
5330 OVERPASS RD STE 110, BUDA, TX 78610-2300
(737) 999-6200
(737) 999-6201
Mailing address
PO BOX 844658, DALLAS, TX 75284-4658
(254) 724-2111
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
036093083
IL
207L00000X
Anesthesiology Physician
Primary
R8105
TX
207LP2900X
Pain Medicine (Anesthesiology) Physician
036093083
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036093083
—
IL
01
—
04932058
BLUE SHIELD OF ILLINOIS
IL
Enumeration date
07/15/2005
Last updated
10/22/2020
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