Individual
DR. BRIAN EDWARD SHOCKLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D P M
Contact information
Practice address
1814 MISSION 66, VICKSBURG, MS 39180-3710
(601) 638-7520
(601) 638-7541
Mailing address
1814 MISSION 66, VICKSBURG, MS 39180-3710
(601) 638-7520
(601) 638-7541
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
Primary
MS80142
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00119033
—
MS
05
—
1540447
—
LA
01
—
1851563
UNITED HEALTHCARE
LA
01
—
1851563
UNITED HEALTHCARE
MS
01
—
4342670001
MEDICARE DME
MS
01
—
4800026580
RAILROAD MEDICARE
LA
01
—
480026580
RAILROAD MEDICARE
MS
01
—
5963224
AETNA
LA
01
—
5963224
AETNA
MS
Enumeration date
08/29/2006
Last updated
01/26/2011
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