Individual
DR. MICHAEL MCSHAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1711 S HENDERSON BLVD, SUITE 100, KILGORE, TX 75662-3563
(903) 315-3800
(903) 984-5367
Mailing address
PO BOX 731218, DALLAS, TX 75373-1218
(903) 315-3800
(903) 984-5367
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
E4519
TX
207Q00000X
Family Medicine Physician
E4519
TX
208D00000X
General Practice Physician
Primary
E4519
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00BP62
BLUE CROSS BLUE SHIELD
TX
05
—
130926203
—
TX
01
—
752883733
TAX ID
TX
Enumeration date
10/26/2006
Last updated
11/14/2014
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