Healthcare Provider Details

I. General information

NPI: 1366432007
Provider Name (Legal Business Name): SHAWN T. GUFFIN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 10/25/2005
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1613 N MCKENZIE ST
FOLEY AL
36535-2247
US

IV. Provider business mailing address

PO BOX 1028
MAGNOLIA SPRINGS AL
36555-1028
US

V. Phone/Fax

Practice location:
  • Phone: 251-965-5393
  • Fax: 251-971-1029
Mailing address:
  • Phone: 251-971-1028
  • Fax: 251-971-1029

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number24962
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: