Provider Demographics
NPI:1487768347
Name:MCSHANE, RICKY MICHAEL (DO)
Entity type:Individual
Prefix:DR
First Name:RICKY
Middle Name:MICHAEL
Last Name:MCSHANE
Suffix:
Gender:M
Credentials:DO
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Mailing Address - Street 1:5151 KATY FWY
Mailing Address - Street 2:#170
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77007-2260
Mailing Address - Country:US
Mailing Address - Phone:713-802-0801
Mailing Address - Fax:713-802-0105
Practice Address - Street 1:5151 KATY FWY
Practice Address - Street 2:#170
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77007-2260
Practice Address - Country:US
Practice Address - Phone:713-802-0801
Practice Address - Fax:713-802-0105
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-18
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TXK2753207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine