Provider Demographics
NPI:1770597163
Name:MCSHAN, MAURICE (MD)
Entity type:Individual
Prefix:DR
First Name:MAURICE
Middle Name:
Last Name:MCSHAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5903 RIDGEWOOD ROAD, SUITE 310
Mailing Address - Street 2:REDDIX MEDICAL GROUP
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39211-3702
Mailing Address - Country:US
Mailing Address - Phone:601-899-3310
Mailing Address - Fax:601-899-3314
Practice Address - Street 1:5903 RIDGEWOOD ROAD, SUITE 310
Practice Address - Street 2:REDDIX MEDICAL GROUP
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39211-3702
Practice Address - Country:US
Practice Address - Phone:601-899-3310
Practice Address - Fax:601-899-3314
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2010-10-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MS15370207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00118687Medicaid
MS110000969Medicare ID - Type Unspecified
MS00118687Medicaid