Provider Demographics
NPI:1164446522
Name:SHAPPLEY, NATHAN P (MD)
Entity Type:Individual
Prefix:DR
First Name:NATHAN
Middle Name:P
Last Name:SHAPPLEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 ALDERSGATE CIR
Mailing Address - Street 2:
Mailing Address - City:HATTIESBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39402-1301
Mailing Address - Country:US
Mailing Address - Phone:601-261-5800
Mailing Address - Fax:601-261-5813
Practice Address - Street 1:101 ALDERSGATE CIR
Practice Address - Street 2:
Practice Address - City:HATTIESBURG
Practice Address - State:MS
Practice Address - Zip Code:39402-1301
Practice Address - Country:US
Practice Address - Phone:601-261-5800
Practice Address - Fax:601-261-5813
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2016-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS06028208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MSD00646Medicare UPIN