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NPI Code Detail

MEDICARE: SHAWN A STUSSY MD

MEDICARE: SHAWN A STUSSY 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
1207Q00000XFamily Medicine PhysicianK1938TX

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
15011750001OTHERTXCIGNA GOVERNMENT SERVICES
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1821082835
Entity Type Code : Individual
Provider Name (Legal Business Name) : SHAWN A STUSSY MD
Provider Business Mailing Address
First Line : 2101 GALLERIA OAKS DR
Second Line :
City : TEXARKANA
State : TX
Zip : 75503-4625
Country : US
Telephone Number : 903-791-9120
Fax Number : 903-791-9132
Provider Business Practice Location Address
First Line : 5212 W 7TH ST
Second Line :
City : WAKE VILLAGE
State : TX
Zip : 75501-5930
Country : US
Telephone Number : 903-831-6848
Fax Number : 903-223-7089
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/06/2005
Last Update Date : 06/13/2014

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Directions to “ SHAWN A STUSSY MD” Practice Location

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