Provider Demographics
NPI:1043213614
Name:SHULKIN, BARRY L (MD)
Entity Type:Individual
Prefix:DR
First Name:BARRY
Middle Name:L
Last Name:SHULKIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:262 DANNY THOMAS PL
Mailing Address - Street 2:MS 515
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38105-3678
Mailing Address - Country:US
Mailing Address - Phone:901-595-3006
Mailing Address - Fax:901-595-3842
Practice Address - Street 1:262 DANNY THOMAS PL
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38105-3678
Practice Address - Country:US
Practice Address - Phone:901-595-3006
Practice Address - Fax:901-595-3842
Is Sole Proprietor?:No
Enumeration Date:2005-05-27
Last Update Date:2012-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN38568207U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207U00000XAllopathic & Osteopathic PhysiciansNuclear Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200490480AMedicaid
LA1470678Medicaid
NJ0063533Medicaid
IA0588517Medicaid
KS200336070AMedicaid
ME422400000Medicaid
TN5440231Medicaid
TX174265201Medicaid
AL009970975Medicaid
VA010175496Medicaid
NV100508086Medicaid
OH2049803Medicaid
MO209285006Medicaid
NC7615332Medicaid
SCQ38568Medicaid
AR154784001Medicaid
KY64096548Medicaid
MS06852550Medicaid
AL009970975Medicaid