Provider Demographics
NPI:1659304673
Name:SHULMAN, EDIE ELIZABETH (MD)
Entity type:Individual
Prefix:DR
First Name:EDIE
Middle Name:ELIZABETH
Last Name:SHULMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:EDIE
Other - Middle Name:E
Other - Last Name:SHULMAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 844658
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-4658
Mailing Address - Country:US
Mailing Address - Phone:254-724-8800
Mailing Address - Fax:
Practice Address - Street 1:1001 WESTBANK DR
Practice Address - Street 2:
Practice Address - City:WEST LAKE HILLS
Practice Address - State:TX
Practice Address - Zip Code:78746-6669
Practice Address - Country:US
Practice Address - Phone:512-654-4150
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-10
Last Update Date:2024-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ1568261Q00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX129250004Medicaid
TX8F7802OtherMEDICARE
TX81413JOtherBCBS
TX8F7802OtherMEDICARE
TX01061728Medicare PIN