Active NPI
Robert Jerald Shore, PHD
- Psychologist
- Tyler, TX
National Provider Identifier
1932326840
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- 24292
- Practice address
- 804 Spring Creek Dr
Tyler, TX 75703-3537 - Phone
- (903) 939-8760
- Fax
- (903) 939-8760
- NPI assigned
- Apr 20, 2007
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychologist | 103T00000X | 24292 | TX | Primary |
Addresses
Primary practice location
804 Spring Creek Dr
Tyler, TX 75703-3537
Mailing address
804 Spring Creek Dr
Tyler, TX 75703-3537
Phone (903) 939-8760
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 11601-160-01 | Medicaid | TX |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 24292 | TX | MD | Psychologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Shore & Associates PC | Psychologist | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Psychologist
- Tyler, TX
- NPI 1093982258
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1177027200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1210809600000",
"number": "1932326840",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "804 SPRING CREEK DR",
"city": "TYLER",
"state": "TX",
"postal_code": "757033537",
"telephone_number": "903-939-8760",
"fax_number": "903-939-8760"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "804 SPRING CREEK DR",
"city": "TYLER",
"state": "TX",
"postal_code": "757033537",
"telephone_number": "903-939-8760",
"fax_number": "903-939-8760"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SHORE",
"first_name": "ROBERT",
"middle_name": "JERALD",
"name_prefix": "Mr.",
"credential": "PHD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-04-20",
"last_updated": "2008-05-15",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "TX",
"license": "24292",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "11601-160-01",
"state": "TX"
}
],
"endpoints": [],
"other_names": []
}Other providers in Tyler, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 15, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.