Provider Demographics
NPI:1548255409
Name:SHOAF, GUY M (MD)
Entity type:Individual
Prefix:DR
First Name:GUY
Middle Name:M
Last Name:SHOAF
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:2500 NORTH STATE STREET
Mailing Address - Street 2:CBO - SUITE 4200
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39216-4500
Mailing Address - Country:US
Mailing Address - Phone:601-496-9794
Mailing Address - Fax:601-815-0434
Practice Address - Street 1:960 J K AVENT DRIVE
Practice Address - Street 2:3 MAIN
Practice Address - City:GRENADA
Practice Address - State:MS
Practice Address - Zip Code:38901
Practice Address - Country:US
Practice Address - Phone:662-227-7575
Practice Address - Fax:662-227-7577
Is Sole Proprietor?:No
Enumeration Date:2005-09-16
Last Update Date:2020-06-04
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Provider Licenses
StateLicense IDTaxonomies
DCMD33918208800000X
MS20458208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILOTH000Medicare UPIN
I24807Medicare UPIN