Provider Demographics
NPI:1376549816
Name:SHEEHAN, JOHN JOSEPH JR (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:JOSEPH
Last Name:SHEEHAN
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:2500 NORTH STATE STREET
Mailing Address - Street 2:DIVISION OF GASTROENTEROLOGY
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39216-4500
Mailing Address - Country:US
Mailing Address - Phone:601-984-4540
Mailing Address - Fax:601-984-4548
Practice Address - Street 1:2500 NORTH STATE STREET
Practice Address - Street 2:DEPARTMENT OF MEDICINE DIVISION OF DIGESTIVE DISEASE
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39216-4500
Practice Address - Country:US
Practice Address - Phone:601-984-4540
Practice Address - Fax:601-984-4548
Is Sole Proprietor?:No
Enumeration Date:2005-06-21
Last Update Date:2014-04-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
LA05144R207RG0100X
MS17272207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS03106560Medicaid
MS5M315OtherP-TAN
LA1303364Medicaid
LA1303364Medicaid
MS5M315OtherP-TAN
MS512I100007Medicare PIN
MS03106560Medicaid