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NPI Code Detail

MEDICARE: GRACE G SHUMAKER M.D.

MEDICARE: GRACE G SHUMAKER M.D.
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
1207RH0003XHematology & Oncology Physician11423MS

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
24389669OTHERAETNA HEALTHCARE

General Provider Information

NPI Number : 1912901513
Entity Type Code : Individual
Provider Name (Legal Business Name) : GRACE G SHUMAKER M.D.
Provider Business Mailing Address
First Line : 1227 N STATE ST
Second Line : STE 101
City : JACKSON
State : MS
Zip : 39202-2002
Country : US
Telephone Number : 601-355-2485
Fax Number : 601-353-1463
Provider Business Practice Location Address
First Line : 1227 N STATE ST
Second Line : STE 101
City : JACKSON
State : MS
Zip : 39202-2002
Country : US
Telephone Number : 601-355-2485
Fax Number : 601-353-1463
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/10/2005
Last Update Date : 04/27/2017

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Directions to “ GRACE G SHUMAKER M.D.” Practice Location

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