Provider Demographics
NPI:1952462905
Name:WU, SHAWN X (MD)
Entity Type:Individual
Prefix:MR
First Name:SHAWN
Middle Name:X
Last Name:WU
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 1:14986 ANGELA DR
Mailing Address - Street 2:
Mailing Address - City:GULFPORT
Mailing Address - State:MS
Mailing Address - Zip Code:39503-3502
Mailing Address - Country:US
Mailing Address - Phone:228-357-5464
Mailing Address - Fax:877-563-0603
Practice Address - Street 1:14986 ANGELA DR
Practice Address - Street 2:
Practice Address - City:GULFPORT
Practice Address - State:MS
Practice Address - Zip Code:39503-3502
Practice Address - Country:US
Practice Address - Phone:228-357-5464
Practice Address - Fax:877-563-0603
Is Sole Proprietor?:No
Enumeration Date:2006-12-13
Last Update Date:2020-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS18988208100000X, 208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00002077Medicaid
MS250000069Medicare ID - Type Unspecified
MS00002077Medicaid