MEDICARE: STEPHEN MILAN SHIRLEY MD

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	07361	MS

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	:	1720044456
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEPHEN MILAN SHIRLEY MD

Provider Business Mailing Address
First Line	:	400 DOCTORS DRIVE
Second Line	:
City	:	NEW ALBANY
State	:	MS
Zip	:	38652
Country	:	US
Telephone Number	:	662-534-5036
Fax Number	:	662-534-9696

Provider Business Practice Location Address
First Line	:	400 DOCTORS DR
Second Line	:
City	:	NEW ALBANY
State	:	MS
Zip	:	38652-3109
Country	:	US
Telephone Number	:	662-534-5036
Fax Number	:	662-534-9696

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

Provider Enumeration Date	:	04/21/2006
Last Update Date	:	02/28/2011

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