Provider Demographics
NPI:1215930029
Name:SHIFFMAN, STEPHEN M (MD)
Entity type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:M
Last Name:SHIFFMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6005 PARK AVE
Mailing Address - Street 2:STE 200
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38119-5212
Mailing Address - Country:US
Mailing Address - Phone:901-761-2100
Mailing Address - Fax:901-682-9351
Practice Address - Street 1:6005 PARK AVE
Practice Address - Street 2:STE 200
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38119-5212
Practice Address - Country:US
Practice Address - Phone:901-761-2100
Practice Address - Fax:901-682-9351
Is Sole Proprietor?:No
Enumeration Date:2005-05-24
Last Update Date:2009-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD007904207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN2007392OtherBLUE CROSS BLUE SHIELD
774030OtherUNITED HEALTHCARE
2576854001OtherCIGNA
4334521OtherAETNA
B03863Medicare UPIN
TN110108321Medicare ID - Type UnspecifiedRAILROAD RETIREMENT BOARD
4334521OtherAETNA