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General NPI Number Information
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NPI Number | 1639417819
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Entity Type | Organization
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Legal Business Name | PHYSICIANS PAIN AND SPINE SPECIALISTS
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Dates
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Enumeration Date | 01/23/2013
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Last Update Date | 01/18/2021
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Provider Practice Location Address
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Address Line | 14986 ANGELA DR
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City | GULFPORT
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State | MS
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Zip | 39503-3502
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Country | US
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Telephone | 228-357-5464
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Fax | 877-563-0603
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Provider Business Mailing Address
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Address Line | 14986 ANGELA DR
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City | GULFPORT
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State | MS
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Zip | 39503-3502
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Country | US
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Telephone | 228-357-5464
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Fax | 877-563-0603
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | MR. SHAWN X WU
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Credential | MD
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Telephone | 248-342-5207
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208VP0014X
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Taxonomy Name | Interventional Pain Medicine Physician
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License Number | 18988
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License Number State | MS
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