Provider Demographics
NPI:1598700577
Name:SHOOP, STEPHEN B (MD)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:B
Last Name:SHOOP
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:STEPHEN
Other - Middle Name:BERNARD
Other - Last Name:SHOOP
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DO
Mailing Address - Street 1:PO BOX 157A
Mailing Address - Street 2:
Mailing Address - City:WHITFIELD
Mailing Address - State:MS
Mailing Address - Zip Code:39193-0157
Mailing Address - Country:US
Mailing Address - Phone:601-351-8000
Mailing Address - Fax:601-351-8301
Practice Address - Street 1:3550 HIGHWAY 468 WEST
Practice Address - Street 2:
Practice Address - City:WHITFIELD
Practice Address - State:MS
Practice Address - Zip Code:39193-0157
Practice Address - Country:US
Practice Address - Phone:601-351-8000
Practice Address - Fax:601-351-8301
Is Sole Proprietor?:No
Enumeration Date:2006-06-16
Last Update Date:2010-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS14597207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00119492Medicaid
MS080003285Medicare ID - Type Unspecified
MS00119492Medicaid