Provider Demographics
NPI:1780959874
Name:SHIMUNOV, SERGEY
Entity type:Individual
Prefix:
First Name:SERGEY
Middle Name:
Last Name:SHIMUNOV
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2204E JOE BATTLE BLVD
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79938-4659
Mailing Address - Country:US
Mailing Address - Phone:915-271-4570
Mailing Address - Fax:915-351-0076
Practice Address - Street 1:2204E JOE BATTLE BLVD
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79938-4659
Practice Address - Country:US
Practice Address - Phone:915-271-4570
Practice Address - Fax:915-351-0076
Is Sole Proprietor?:No
Enumeration Date:2012-03-21
Last Update Date:2019-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXR3214208600000X, 208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery