Basic Information
| Provider Information | |||||||||
| NPI: | 1003947961 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | COLE | ||||||||
| FirstName: | SHANE | ||||||||
| MiddleName: | PARKER | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | DEPT 960349 | ||||||||
| Address2: | |||||||||
| City: | OKLAHOMA CITY | ||||||||
| State: | OK | ||||||||
| PostalCode: | 731960349 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4058441830 | ||||||||
| FaxNumber: | 4053419217 | ||||||||
| Practice Location | |||||||||
| Address1: | 801 INTERSTATE 20 W | ||||||||
| Address2: | USMD HOSP -- ER DEPT | ||||||||
| City: | ARLINGTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 760175851 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8174723400 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/09/2007 | ||||||||
| LastUpdateDate: | 09/22/2010 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | LL 29020 | SC | N | Allopathic & Osteopathic Physicians | Emergency Medicine | 207P00000X | TEMP MED LICENSE | TX | N | Allopathic & Osteopathic Physicians | Emergency Medicine | 207P00000X | N3571 | TX | Y | Allopathic & Osteopathic Physicians | Emergency Medicine |
ID Information
| ID | Type | State | Issuer | Description | P00834182 | 01 | RR MCARE THRU AEMA | OTHER | 204092502 | 05 | TX | MEDICAID | P00791718 | 01 | RR MCARE THRU SAEMA | OTHER | 204092501 | 05 | TX | MEDICAID | 8BT331 | 01 | TX | BCBS TX | OTHER |