Individual
SHAWN SHADELL FUGATE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
313 S CHERRY ST, PINEVILLE, KY 40977-1724
(606) 654-3338
(606) 654-2273
Mailing address
526 W KENTUCKY AVE, PINEVILLE, KY 40977-1343
(606) 337-3223
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
26778
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000068941
BLUE CROSS
KY
05
—
64267784
—
KY
Enumeration date
05/31/2006
Last updated
01/16/2019
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