Timothy Ray Shann, MD | |
509 Brookman Dr, Brookhaven, MS 39601-2326 | |
(601) 823-5204 | |
(601) 833-1224 |
Full Name | Timothy Ray Shann |
---|---|
Gender | Male |
Speciality | Pediatrics |
Location | 509 Brookman Dr, Brookhaven, Mississippi |
Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
Identifier | Type | State | Issuer |
---|---|---|---|
1477518793 | NPI | - | NPPES |
731310891006 | Other | OK | UNICARE |
731310891028 | Other | OK | TRICARE SOUTH |
100253110A | Medicaid | OK | |
100253110A | Other | OK | SOONER PCP |
74502A041 | Other | OK | CHAMPUS (WPS) |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
208000000X | Pediatrics | 21817 (Oklahoma) | Primary |
Entity Name | Kings Daughters Medical Center |
---|---|
Entity Type | Part B Supplier - Clinic/group Practice |
Entity Identifiers | NPI Number: 1043245368 PECOS PAC ID: 3072575539 Enrollment ID: O20041028000174 |
Entity Name | Kdmc Physician Clinics Llc |
---|---|
Entity Type | Part B Supplier - Clinic/group Practice |
Entity Identifiers | NPI Number: 1861739161 PECOS PAC ID: 7012154495 Enrollment ID: O20130501000541 |
Mailing Address | Practice Location Address |
---|---|
Timothy Ray Shann, MD 509 Brookman Dr, Brookhaven, MS 39601-2326 Ph: (601) 823-5204 | Timothy Ray Shann, MD 509 Brookman Dr, Brookhaven, MS 39601-2326 Ph: (601) 823-5204 |
Joshua William Iles, M.D. Pediatrics Medicare: Medicare Enrolled Practice Location: 509 Brookman Dr, Brookhaven, MS 39601 Phone: 601-823-5204 Fax: 601-833-1224 | |
Charles Mitchell Holland, M.D. Pediatrics Medicare: Medicare Enrolled Practice Location: 509 Brookman Dr, Brookhaven, MS 39601 Phone: 601-823-5204 Fax: 601-833-1224 | |
David Steven Braden, M.D. Pediatrics Medicare: Accepting Medicare Assignments Practice Location: 624 Highway 51 N, Brookhaven, MS 39601 Phone: 601-835-2100 Fax: 601-835-0451 | |
Dr. Jackson Scott Thomas, MD Pediatrics Medicare: Medicare Enrolled Practice Location: 427 Highway 51 N, Brookhaven, MS 39601 Phone: 601-835-9270 Fax: 601-833-5210 |