Provider Demographics
NPI:1134122708
Name:SHOCHAT, STEPHEN J (MD)
Entity type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:J
Last Name:SHOCHAT
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 1:262 DANNY THOMAS PL
Mailing Address - Street 2:MS 515
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38105-3678
Mailing Address - Country:US
Mailing Address - Phone:901-595-3006
Mailing Address - Fax:901-595-3842
Practice Address - Street 1:262 DANNY THOMAS PL
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38105-3678
Practice Address - Country:US
Practice Address - Phone:901-595-3006
Practice Address - Fax:901-595-3842
Is Sole Proprietor?:No
Enumeration Date:2005-05-27
Last Update Date:2012-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN256262086S0120X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0120XAllopathic & Osteopathic PhysiciansSurgeryPediatric Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR132329001Medicaid
MO208932400Medicaid
MS00117974Medicaid
IA0527937Medicaid
OK100029750AMedicaid
MI104632095Medicaid
TN3810226Medicaid
LA1544400Medicaid
OH2006313Medicaid
AL009914140Medicaid
TX060512301Medicaid
ME422400000Medicaid
IN200179280AMedicaid
NC7612401Medicaid
SCQ28626Medicaid
VA006705511Medicaid
WY1135201 00Medicaid
KY64926553Medicaid
VA006705511Medicaid