Provider Demographics
NPI:1902898356
Name:SHISLER, STEPHANIE R (MD)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:R
Last Name:SHISLER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1005 W RALPH HALL PKWY STE 107
Mailing Address - Street 2:
Mailing Address - City:ROCKWALL
Mailing Address - State:TX
Mailing Address - Zip Code:75032-6663
Mailing Address - Country:US
Mailing Address - Phone:469-769-1961
Mailing Address - Fax:469-769-1905
Practice Address - Street 1:1005 W RALPH HALL PKWY STE 107
Practice Address - Street 2:
Practice Address - City:ROCKWALL
Practice Address - State:TX
Practice Address - Zip Code:75032-6663
Practice Address - Country:US
Practice Address - Phone:469-769-1961
Practice Address - Fax:469-769-1905
Is Sole Proprietor?:No
Enumeration Date:2005-08-19
Last Update Date:2023-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036098340174400000X
TXN4097207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX208716503Medicaid
TX208716502Medicaid
TX208716503Medicaid
ILK45089Medicare PIN
TX316151YKP5Medicare PIN
TX208716502Medicaid
TX316151YKQLMedicare PIN