Individual
JAY GORDON SHIRES
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
294 SUMMAR DR, JACKSON, TN 38301-3915
(731) 423-1932
(731) 265-8355
Mailing address
PO BOX 11942, JACKSON, TN 38308-0132
(731) 660-2665
(731) 660-2121
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
MD0000045650
TN
207Q00000X
Family Medicine Physician
Primary
45650
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1519909
—
TN
Enumeration date
04/10/2008
Last updated
09/09/2020
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