Provider Demographics
NPI:1053344580
Name:PARSLEY, SHAWN D (DO)
Entity type:Individual
Prefix:
First Name:SHAWN
Middle Name:D
Last Name:PARSLEY
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 1:6100 LAKE WORTH BLVD
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76135-3703
Mailing Address - Country:US
Mailing Address - Phone:817-237-3321
Mailing Address - Fax:817-237-7970
Practice Address - Street 1:6100 LAKE WORTH BLVD
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76135-3703
Practice Address - Country:US
Practice Address - Phone:817-237-3321
Practice Address - Fax:817-237-7970
Is Sole Proprietor?:No
Enumeration Date:2006-07-08
Last Update Date:2015-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ9257207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX046236802Medicaid
TX046236805Medicaid
TX046236803Medicaid
TXTXB121954Medicare PIN
TX8C9787Medicare PIN
TX8L2165Medicare PIN
TX046236802Medicaid