Provider Demographics
NPI:1215333067
Name:DFW WOUND CARE
Entity type:Organization
Organization Name:DFW WOUND CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SHANNON
Authorized Official - Middle Name:B
Authorized Official - Last Name:PAYSEUR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:469-277-2701
Mailing Address - Street 1:5600 W LOVERS LN
Mailing Address - Street 2:116-312
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75209-4330
Mailing Address - Country:US
Mailing Address - Phone:469-277-2701
Mailing Address - Fax:469-277-2703
Practice Address - Street 1:17051 DALLAS PKWY STE 250
Practice Address - Street 2:
Practice Address - City:ADDISON
Practice Address - State:TX
Practice Address - Zip Code:75001-7121
Practice Address - Country:US
Practice Address - Phone:469-277-2701
Practice Address - Fax:469-277-2703
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-06
Last Update Date:2020-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207Q00000X
TXM08582083P0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
No2083P0011XAllopathic & Osteopathic PhysiciansPreventive MedicineUndersea and Hyperbaric MedicineGroup - Multi-Specialty