Provider Demographics
NPI:1861440026
Name:SHUGART, LEROY E (PA)
Entity Type:Individual
Prefix:MR
First Name:LEROY
Middle Name:E
Last Name:SHUGART
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
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Mailing Address - Street 1:1119 COUNTRYSIDE DR
Mailing Address - Street 2:
Mailing Address - City:MCPHERSON
Mailing Address - State:KS
Mailing Address - Zip Code:67460-2109
Mailing Address - Country:US
Mailing Address - Phone:620-241-4205
Mailing Address - Fax:620-532-0167
Practice Address - Street 1:750 W D AVE
Practice Address - Street 2:
Practice Address - City:KINGMAN
Practice Address - State:KS
Practice Address - Zip Code:67068-1266
Practice Address - Country:US
Practice Address - Phone:620-532-3147
Practice Address - Fax:620-532-3147
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-04
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KS1500190363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
KSR30936Medicare UPIN