MEDICARE: DR. MAURICE MCSHAN M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	15370	MS

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1770597163
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MAURICE MCSHAN M.D.

Provider Business Mailing Address
First Line	:	5903 RIDGEWOOD ROAD, SUITE 310
Second Line	:	REDDIX MEDICAL GROUP
City	:	JACKSON
State	:	MS
Zip	:	39211-3702
Country	:	US
Telephone Number	:	601-899-3310
Fax Number	:	601-899-3314

Provider Business Practice Location Address
First Line	:	5903 RIDGEWOOD ROAD, SUITE 310
Second Line	:	REDDIX MEDICAL GROUP
City	:	JACKSON
State	:	MS
Zip	:	39211-3702
Country	:	US
Telephone Number	:	601-899-3310
Fax Number	:	601-899-3314

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/28/2006
Last Update Date	:	10/28/2010

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