Provider Demographics
NPI:1730366683
Name:SHAWN BONSELL MD PA
Entity type:Organization
Organization Name:SHAWN BONSELL MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:SHAWN
Authorized Official - Middle Name:C
Authorized Official - Last Name:BONSELL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:214-824-7744
Mailing Address - Street 1:1015 N CARROLL AVE STE 2000
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75204-6607
Mailing Address - Country:US
Mailing Address - Phone:214-824-7744
Mailing Address - Fax:214-824-7755
Practice Address - Street 1:1015 N CARROLL AVE STE 2000
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75204-6607
Practice Address - Country:US
Practice Address - Phone:214-824-7744
Practice Address - Fax:214-824-7755
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-23
Last Update Date:2008-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK8016207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX146533803Medicaid
TX146533803Medicaid