Provider Demographics
NPI:1831214808
Name:SHOGREN, DAWN LESLIE (MD)
Entity type:Individual
Prefix:
First Name:DAWN
Middle Name:LESLIE
Last Name:SHOGREN
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 1:5485 BELT LINE RD STE 160
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75254-7672
Mailing Address - Country:US
Mailing Address - Phone:972-392-2882
Mailing Address - Fax:972-392-4407
Practice Address - Street 1:5485 BELT LINE RD STE 160
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75254-7672
Practice Address - Country:US
Practice Address - Phone:972-392-2882
Practice Address - Fax:972-392-4407
Is Sole Proprietor?:No
Enumeration Date:2007-03-20
Last Update Date:2021-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG64542084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
00J60BOtherBCBS
00J60BOtherBCBS
E79486Medicare UPIN