Provider Demographics
NPI:1437213337
Name:BAILEY, SHANE MICHAEL (MD)
Entity type:Individual
Prefix:DR
First Name:SHANE
Middle Name:MICHAEL
Last Name:BAILEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:479 OXFORD DR STE 104
Mailing Address - Street 2:
Mailing Address - City:NEW BRAUNFELS
Mailing Address - State:TX
Mailing Address - Zip Code:78130-7423
Mailing Address - Country:US
Mailing Address - Phone:830-214-0300
Mailing Address - Fax:830-214-0397
Practice Address - Street 1:479 OXFORD DR STE 104
Practice Address - Street 2:
Practice Address - City:NEW BRAUNFELS
Practice Address - State:TX
Practice Address - Zip Code:78130-7423
Practice Address - Country:US
Practice Address - Phone:830-214-0300
Practice Address - Fax:830-214-0397
Is Sole Proprietor?:No
Enumeration Date:2006-12-22
Last Update Date:2023-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM6031207RC0000X, 207RC0001X, 207RC0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac Electrophysiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX190668702Medicaid
TX190668701Medicaid
TX451498YNTUOtherMEDICARE PROVIDER NUMBER:
TXP00470579OtherMEDICARE RAILROAD
TX8K2996Medicare PIN
TXP00470579OtherMEDICARE RAILROAD
TX190668701Medicaid