| Tony Shallin, Mdpa | |
|
3613 Williams Dr Ste 404 Georgetown TX 78628-1370 | |
| (512) 930-4275 | |
| (512) 930-4093 |
| Full Name | Tony Shallin, Mdpa |
|---|---|
| Speciality | Internal Medicine |
| Location | 3613 Williams Dr Ste 404, Georgetown, Texas |
| Authorized Official Name and Position | Tony Shallin (OWNER/PHYSICIAN) |
| Authorized Official Contact | 5129304275 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Tony Shallin, Mdpa 3613 Williams Dr Ste 404 Georgetown TX 78628-1370 Ph: (512) 930-4275 | Tony Shallin, Mdpa 3613 Williams Dr Ste 404 Georgetown TX 78628-1370 Ph: (512) 930-4275 |
| NPI Number | 1811183924 |
|---|---|
| Provider Enumeration Date | 09/21/2007 |
| Last Update Date | 08/21/2024 |
| Medicare PECOS PAC ID | 7214982388 |
|---|---|
| Medicare Enrollment ID | O20050322000489 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1811183924 | NPI | - | NPPES |
| 172700001 | Medicaid | TX |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | J2323 (Texas) | Primary |
| Provider Name | Anthony Shallin |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1891734968 PECOS PAC ID: 5294780367 Enrollment ID: I20050324000875 |
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