Provider Demographics
NPI:1194716035
Name:SHORE, JOHN W (MD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:W
Last Name:SHORE
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Gender:M
Credentials:MD
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Mailing Address - Street 1:3705 MEDICAL PKWY
Mailing Address - Street 2:SUITE 120
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78705-1019
Mailing Address - Country:US
Mailing Address - Phone:512-458-2141
Mailing Address - Fax:512-458-4824
Practice Address - Street 1:3705 MEDICAL PKWY
Practice Address - Street 2:SUITE 120
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78705-1019
Practice Address - Country:US
Practice Address - Phone:512-458-2141
Practice Address - Fax:512-458-4824
Is Sole Proprietor?:No
Enumeration Date:2005-10-31
Last Update Date:2016-05-02
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TXF2001207W00000X, 207WX0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207WX0200XAllopathic & Osteopathic PhysiciansOphthalmologyOphthalmic Plastic and Reconstructive Surgery
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX124724903Medicaid
TX89601BMedicare PIN
TX124724903Medicaid