Individual
JERRY M SHUCK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
35-023697
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000221200
UNISON
OH
01
—
000000503718
ANTHEM
—
05
—
0421985
—
OH
01
—
364009
WELLCARE
OH
01
—
4007916
AETNA
—
01
—
738099
BUCKEYE
OH
Enumeration date
07/15/2006
Last updated
06/30/2011
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