Basic Information
| Provider Information | |||||||||
| NPI: | 1639533466 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SHEN | ||||||||
| FirstName: | HARRY | ||||||||
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| Mailing Information | |||||||||
| Address1: | 387 W INTERSTATE 10 | ||||||||
| Address2: | |||||||||
| City: | FORT STOCKTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 797352700 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 1500 S MAIN ST | ||||||||
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| City: | FT WORTH | ||||||||
| State: | TX | ||||||||
| PostalCode: | 761044917 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8177023431 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/07/2016 | ||||||||
| LastUpdateDate: | 10/20/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/20/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | R9433 | TX | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.