Provider Demographics
NPI:1326257387
Name:ZHANG, SHU (MD)
Entity Type:Individual
Prefix:DR
First Name:SHU
Middle Name:
Last Name:ZHANG
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 1:301 MOOREWOOD ST APT 1014
Mailing Address - Street 2:
Mailing Address - City:EL DORADO
Mailing Address - State:AR
Mailing Address - Zip Code:71730-2990
Mailing Address - Country:US
Mailing Address - Phone:318-834-9029
Mailing Address - Fax:870-881-4497
Practice Address - Street 1:460 W OAK ST
Practice Address - Street 2:
Practice Address - City:EL DORADO
Practice Address - State:AR
Practice Address - Zip Code:71730-4567
Practice Address - Country:US
Practice Address - Phone:870-862-2489
Practice Address - Fax:870-881-4497
Is Sole Proprietor?:No
Enumeration Date:2007-05-22
Last Update Date:2009-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
ARE-5974207Q00000X
CO48212207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO84429216Medicaid
CO306026Medicare PIN