Provider Demographics
NPI:1033473772
Name:HUGHES, SHAWN GERARD (DO)
Entity Type:Individual
Prefix:DR
First Name:SHAWN
Middle Name:GERARD
Last Name:HUGHES
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1005 MAR WALT DRIVE
Mailing Address - Street 2:
Mailing Address - City:FORT WALTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32547-6796
Mailing Address - Country:US
Mailing Address - Phone:850-863-8182
Mailing Address - Fax:850-863-9614
Practice Address - Street 1:999 MAR WALT DR
Practice Address - Street 2:
Practice Address - City:FORT WALTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:32547
Practice Address - Country:US
Practice Address - Phone:850-863-8182
Practice Address - Fax:850-863-9614
Is Sole Proprietor?:No
Enumeration Date:2012-06-27
Last Update Date:2018-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS14379207LP2900X, 207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLJA197ZOtherMEDICARE PTAN
FL020490500Medicaid
FLDR29WOtherFLORIDA BLUE