Provider Demographics
NPI:1902895568
Name:SHRUM, KIM RAY (MD)
Entity Type:Individual
Prefix:
First Name:KIM
Middle Name:RAY
Last Name:SHRUM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18545 W LAKE HOUSTON PKWY
Mailing Address - Street 2:
Mailing Address - City:HUMBLE
Mailing Address - State:TX
Mailing Address - Zip Code:77346-3392
Mailing Address - Country:US
Mailing Address - Phone:281-812-4000
Mailing Address - Fax:281-812-3331
Practice Address - Street 1:18545 W LAKE HOUSTON PKWY
Practice Address - Street 2:
Practice Address - City:HUMBLE
Practice Address - State:TX
Practice Address - Zip Code:77346-3392
Practice Address - Country:US
Practice Address - Phone:281-812-4000
Practice Address - Fax:281-812-3331
Is Sole Proprietor?:No
Enumeration Date:2005-10-17
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL2649207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX145199904Medicaid
TX145199905Medicaid
4198390002OtherDME PALMETTO
7114117OtherAETNA
21210202328OtherBEECHSTREET
5248990OtherCCN FIRST HEALTH
TX8B7450OtherBLUE CROSS BLUE SHIELD
975250OtherONE HEALTH PLAN
4119904OtherCIGNA
4198390001OtherDME PALMETTO
7114117OtherAETNA
TX8B7450OtherBLUE CROSS BLUE SHIELD
5248990OtherCCN FIRST HEALTH
TX145199905Medicaid