MEDICARE: DR. MARK W. SHEN D.O.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	2003005211	MO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1265401285
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARK W. SHEN D.O.

Provider Business Mailing Address
First Line	:	54 HOSPITAL DR
Second Line	:
City	:	OSAGE BEACH
State	:	MO
Zip	:	65065-3050
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1057 MEDICAL PARK DR
Second Line	:	SUITE A
City	:	OSAGE BEACH
State	:	MO
Zip	:	65065-3000
Country	:	US
Telephone Number	:	573-348-2745
Fax Number	:	573-348-8279

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/14/2006
Last Update Date	:	01/28/2009

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