Provider Demographics
NPI:1144544149
Name:CHARLES B SHUEY JR MD PA
Entity type:Organization
Organization Name:CHARLES B SHUEY JR MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:B
Authorized Official - Last Name:SHUEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:214-384-3734
Mailing Address - Street 1:3701 JUNIUS ST # B010
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75246-2026
Mailing Address - Country:US
Mailing Address - Phone:214-796-3439
Mailing Address - Fax:877-720-0539
Practice Address - Street 1:3600 GASTON AVE
Practice Address - Street 2:SUITE 210
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75246-1800
Practice Address - Country:US
Practice Address - Phone:214-796-3439
Practice Address - Fax:877-720-0539
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-19
Last Update Date:2011-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXC9136207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX120409101Medicaid
TXTXB112955OtherMEDICARE BILLING PTAN
TX120409101Medicaid
TXC21791Medicare UPIN