Provider Demographics
NPI:1518940469
Name:SHOOK, MARSHALL SHANNON II (MD)
Entity Type:Individual
Prefix:DR
First Name:MARSHALL
Middle Name:SHANNON
Last Name:SHOOK
Suffix:II
Gender:M
Credentials:MD
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Mailing Address - Street 1:955 RIBAUT RD
Mailing Address - Street 2:BMAC CREDENTIALING
Mailing Address - City:BEAUFORT
Mailing Address - State:SC
Mailing Address - Zip Code:29902-5441
Mailing Address - Country:US
Mailing Address - Phone:843-522-5674
Mailing Address - Fax:843-522-5678
Practice Address - Street 1:BEAUFORT MEMORIAL HEART SPECIALISTS
Practice Address - Street 2:300 MIDTOWN DRIVE
Practice Address - City:BEAUFORT
Practice Address - State:SC
Practice Address - Zip Code:29906-5200
Practice Address - Country:US
Practice Address - Phone:843-770-0404
Practice Address - Fax:844-295-9872
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-23
Last Update Date:2019-07-25
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Provider Licenses
StateLicense IDTaxonomies
FLME102688207R00000X
TN42970207R00000X
SC24622207R00000X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC246228Medicaid