Provider Demographics
NPI:1043646730
Name:SHANON G SCHWIMMER MD PA
Entity type:Organization
Organization Name:SHANON G SCHWIMMER MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SHANON
Authorized Official - Middle Name:GERVAISE
Authorized Official - Last Name:SCHWIMMER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:214-522-0210
Mailing Address - Street 1:PO BOX 141023
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75214-1023
Mailing Address - Country:US
Mailing Address - Phone:214-522-0210
Mailing Address - Fax:214-522-0474
Practice Address - Street 1:3535 TRAVIS ST
Practice Address - Street 2:SUITE 210
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75204-1465
Practice Address - Country:US
Practice Address - Phone:214-522-0210
Practice Address - Fax:214-522-0474
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-25
Last Update Date:2013-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL0577207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty