Healthcare Provider Details

I. General information

NPI: 1144467317
Provider Name (Legal Business Name): JOHN DOUGLAS SHUGRUE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/09/2009
Last Update Date: 05/30/2021
Certification Date: 05/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

206 COUNTY ROAD 304
CALERA AL
35040-6900
US

IV. Provider business mailing address

2341 JOHN HAWKINS PKWY STE 133
HOOVER AL
35244-3505
US

V. Phone/Fax

Practice location:
  • Phone: 205-668-0626
  • Fax: 205-668-4564
Mailing address:
  • Phone: 205-557-4450
  • Fax: 251-589-6595

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD.29979
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: