Basic Information
| Provider Information | |||||||||
| NPI: | 1598873127 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SHUMWAY | ||||||||
| FirstName: | JUDY | ||||||||
| MiddleName: | TAN | ||||||||
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| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7330 SAN PEDRO | ||||||||
| Address2: | STE. 405 | ||||||||
| City: | SAN ANTONIO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 782166235 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2103442673 | ||||||||
| FaxNumber: | 2103442649 | ||||||||
| Practice Location | |||||||||
| Address1: | 7330 SAN PEDRO | ||||||||
| Address2: | STE. 405 | ||||||||
| City: | SAN ANTONIO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 782166235 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2103442673 | ||||||||
| FaxNumber: | 2103442649 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/25/2006 | ||||||||
| LastUpdateDate: | 11/26/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | M4540 | TX | Y | Allopathic & Osteopathic Physicians | Internal Medicine | 208M00000X | M4540 | TX | N | Allopathic & Osteopathic Physicians | Hospitalist |
ID Information
| ID | Type | State | Issuer | Description | BS9808493 | 01 | TX | DEA | OTHER |