Healthcare Provider Details

I. General information

NPI: 1306819891
Provider Name (Legal Business Name): EUGENE LINWOOD SHANNON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/07/2006
Last Update Date: 05/01/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

62 OLD AIRPORT RD
HATTIESBURG MS
39401-8382
US

IV. Provider business mailing address

PO BOX 1729
HATTIESBURG MS
39403-1729
US

V. Phone/Fax

Practice location:
  • Phone: 601-544-4550
  • Fax: 601-582-3373
Mailing address:
  • Phone: 601-545-8700
  • Fax: 601-450-2493

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number06886
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: