Individual
JASON LEE SHIVES
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
102 SHELBY SPEIGHTS DR, PURVIS, MS 39475-4151
(601) 794-8065
(601) 794-5650
Mailing address
102 SHELBY SPEIGHTS DR, PURVIS, MS 39475-4151
(601) 794-8065
(601) 794-5650
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
MD470029
PA
207P00000X
Emergency Medicine Physician
ME102839
FL
207Q00000X
Family Medicine Physician
Primary
21360
MS
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
11/25/2009
Last updated
11/03/2021
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