Provider Demographics
NPI:1336441419
Name:COUGHLIN, SHANE W (MD)
Entity type:Individual
Prefix:
First Name:SHANE
Middle Name:W
Last Name:COUGHLIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1407 UNION AVE
Mailing Address - Street 2:SUITE 640
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38104-3666
Mailing Address - Country:US
Mailing Address - Phone:901-866-8360
Mailing Address - Fax:901-302-2360
Practice Address - Street 1:1407 UNION AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38104-3600
Practice Address - Country:US
Practice Address - Phone:901-866-8813
Practice Address - Fax:901-302-2120
Is Sole Proprietor?:No
Enumeration Date:2010-11-23
Last Update Date:2020-07-15
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
PAMT213433207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine