Healthcare Provider Details

I. General information

NPI: 1326257387
Provider Name (Legal Business Name): SHU ZHANG M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/22/2007
Last Update Date: 11/20/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

460 W OAK ST
EL DORADO AR
71730-4567
US

IV. Provider business mailing address

301 MOOREWOOD ST APT 1014
EL DORADO AR
71730-2990
US

V. Phone/Fax

Practice location:
  • Phone: 870-862-2489
  • Fax: 870-881-4497
Mailing address:
  • Phone: 318-834-9029
  • Fax: 870-881-4497

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberE-5974
License Number StateAR
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number48212
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: