Provider Demographics
NPI:1487768347
Name:MCSHANE, RICKY MICHAEL (DO)
Entity type:Individual
Prefix:DR
First Name:RICKY
Middle Name:MICHAEL
Last Name:MCSHANE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7611 VISTA CIR
Mailing Address - Street 2:
Mailing Address - City:PARK CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84098-5739
Mailing Address - Country:US
Mailing Address - Phone:281-684-1328
Mailing Address - Fax:
Practice Address - Street 1:5151 KATY FWY
Practice Address - Street 2:#170
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77007-2260
Practice Address - Country:US
Practice Address - Phone:713-802-0801
Practice Address - Fax:713-802-0105
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-18
Last Update Date:2025-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK27532083X0100X
UT10955328-12042083X0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational Medicine