Provider Demographics
NPI:1699938498
Name:SULTAN, SHAHJAHAN (MD)
Entity type:Individual
Prefix:
First Name:SHAHJAHAN
Middle Name:
Last Name:SULTAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1206 IOLA RD
Mailing Address - Street 2:
Mailing Address - City:OCEAN SPRINGS
Mailing Address - State:MS
Mailing Address - Zip Code:39564-2819
Mailing Address - Country:US
Mailing Address - Phone:228-215-1004
Mailing Address - Fax:228-238-3035
Practice Address - Street 1:1019 GOVERNMENT ST STE D
Practice Address - Street 2:
Practice Address - City:OCEAN SPRINGS
Practice Address - State:MS
Practice Address - Zip Code:39564-3862
Practice Address - Country:US
Practice Address - Phone:228-215-1004
Practice Address - Fax:228-238-3035
Is Sole Proprietor?:No
Enumeration Date:2008-07-02
Last Update Date:2014-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMT192586207R00000X
MS21500207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine