MEDICARE: DR. SUSAN MARIE SHATTUCK 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
1	207V00000X	Obstetrics & Gynecology Physician	013942	LA

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	:	1962409508
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SUSAN MARIE SHATTUCK M.D.

Provider Business Mailing Address
First Line	:	8001 YOUREE DR STE 350
Second Line	:
City	:	SHREVEPORT
State	:	LA
Zip	:	71115-2330
Country	:	US
Telephone Number	:	318-524-0114
Fax Number	:	318-524-0195

Provider Business Practice Location Address
First Line	:	8001 YOUREE DR
Second Line	:	SUITE 350
City	:	SHREVEPORT
State	:	LA
Zip	:	71115-2302
Country	:	US
Telephone Number	:	318-524-0114
Fax Number	:	318-524-0195

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

Provider Enumeration Date	:	06/28/2005
Last Update Date	:	05/18/2011

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