Provider Demographics
NPI:1316904550
Name:SHAUGHNESSY, PAUL J (MD)
Entity type:Individual
Prefix:DR
First Name:PAUL
Middle Name:J
Last Name:SHAUGHNESSY
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:8109 FREDERICKSBURG RD
Mailing Address - Street 2:PHYSICIAN PRACTICE SERVICES
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-3311
Mailing Address - Country:US
Mailing Address - Phone:210-575-3817
Mailing Address - Fax:210-575-4113
Practice Address - Street 1:7700 FLOYD CURL DR
Practice Address - Street 2:10TH FLOOR
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-3902
Practice Address - Country:US
Practice Address - Phone:210-575-3817
Practice Address - Fax:210-575-4113
Is Sole Proprietor?:No
Enumeration Date:2006-05-01
Last Update Date:2018-01-02
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Provider Licenses
StateLicense IDTaxonomies
TXK5002207RH0003X, 207R00000X, 207RH0000X
TXJ2487207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RH0000XAllopathic & Osteopathic PhysiciansInternal MedicineHematology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8BX130OtherBCBS
TX149858605Medicaid
TX8F9872OtherMEDICARE
149858606OtherCSHCN