DR. BRIAN EDWARD SHOCKLEY (NPI# 1477662229) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1477662229 |
| Entity Type | Individual |
| Full Name | DR. BRIAN EDWARD SHOCKLEY |
| Credential | D P M |
| Practice Address |
1814 Mission 66 Vicksburg MS 39180-3710 |
| Practice Telephone | 6016387520 |
| Practice Fax Number | 6016387541 |
| Mailing Telephone | 6016387520 |
| Mailing Fax Number | 6016387541 |
| Enumeration Date | 2006-08-29 |
| Last Update Date | 2011-01-26 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 213E00000X | Podiatrist | MS80142 | MS | Podiatric Medicine & Surgery Service Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| LA | 1540447 | 05 | |
| MS | UNITED HEALTHCARE | 1851563 | 01 |
| MS | AETNA | 5963224 | 01 |
| MS | 00119033 | 05 | |
| LA | AETNA | 5963224 | 01 |
| LA | UNITED HEALTHCARE | 1851563 | 01 |
| MS | RAILROAD MEDICARE | 480026580 | 01 |
| MS | MEDICARE DME | 4342670001 | 01 |
| LA | RAILROAD MEDICARE | 4800026580 | 01 |
| Street Address |
1814 MISSION 66 |
| City | VICKSBURG |
| State | MS |
| Zip Code | 39180-3710 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1962689042 | Delta Foot Clinics, Inc | Clinic/Center | 1814 Mission 66, Vicksburg, MS 39180-3710 | 2008-01-30 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1255877346 | Elite Performance and Rehab, LLC | Clinic/Center | 1901 A Mission 66, Vicksburg, MS 39180 | 2017-01-12 |
| 1679931083 | Heather M Anderson | Physician Assistant | 2080 S Frontage Rd Ste 100, Vicksburg, MS 39180 | 2016-02-01 |
| 1245604941 | Warren County Assn.for Retarded Citizens, Inc. | Day Training, Developmentally Disabled Services | 100 Smokey Lane, Vicksburg, MS 39180 | 2015-11-18 |
| 1386012904 | Brian Oliver Snowden | Counselor | 3530 Manor Dr Ste 5a, Vicksburg, MS 39180 | 2015-09-14 |
| 1962802710 | Jordan P. Crocker, D.m.d., Pllc | Clinic/Center | 109 Monument Place, Vicksburg, MS 39180 | 2014-08-29 |
| 1821434259 | Trisha Addison | Physical Therapist | 2222 South Frontage Road, Suite D, Vicksburg, MS 39180 | 2013-05-13 |
| 1073862157 | Laura Jeanne Briggs | Physical Therapist | 1901-a Mission 66, Vicksburg, MS 39180 | 2012-09-05 |
| 1912175258 | Andrea T. Harris | Counselor | Warren-yazoo Mental Health Service, 3444 Wisconsin Ave., Vicksburg, MS 39180 | 2008-02-20 |
| 1922217314 | Austin Family Dentistry | Dentist | 3040 Indiana Ave, Vicksburg, MS 39180 | 2007-05-22 |
| 1063539138 | Ollie Hardaway Jr. | Dentist | 154 Cottonwood Street, Vicksburg, MS 39180 | 2007-03-23 |
| Find all providers in zip 39180 | ||||
| Taxonomy Code | 213E00000X |
| Grouping | Podiatric Medicine & Surgery Service Providers |
| Classification | Podiatrist |
| A podiatrist is a person qualified by a Doctor of Podiatric Medicine (D.P.M.) degree, licensed by the state, and practicing within the scope of that license. Podiatrists diagnose and treat foot diseases and deformities. They perform medical, surgical and other operative procedures, prescribe corrective devices and prescribe and administer drugs and physical therapy. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1518527688 | Ortho Express Holding Company, LLC | Podiatrist | 1200 Office Park Dr, Oxford, MS 38655-3597 | 2019-06-19 |
| 1932682515 | Feltz Vision Center Ms LLC | Podiatrist | 7716 Old Canton Rd Ste C, Madison, MS 39110-9299 | 2018-09-11 |
| 1881193449 | Dr Michael S Zaleski | Podiatrist | 2310 4th St Ste A, Meridian, MS 39301-5819 | 2018-02-08 |
| 1760905145 | Dr Michael S Zaleski | Podiatrist | 206 Bay Ave Ste A, Richton, MS 39476-2941 | 2017-07-18 |
| 1184009086 | River Health Care, LLC | Podiatrist | 426 Abbey Woods, Brandon, MS 39047-7719 | 2015-07-21 |
| 1528440195 | Dr Michael S. Zaleski | Podiatrist | 104 Partnership Way, Columbia, MS 39429-4502 | 2015-06-19 |
| 1982091096 | Aaron Israel | Podiatrist | 1837 Cooper Rd., Picayune, MS 39466-5576 | 2015-04-16 |
| 1689096612 | Podiatry Group Inc | Podiatrist | 122 5th Ave, Suite A, Mccomb, MS 39648-4159 | 2014-01-10 |
| 1417234022 | Podiatry Associates Pllc | Podiatrist | 56 Sgt Prentiss Dr, Natchez, MS 39120-4726 | 2011-11-10 |
| 1649413246 | Glossie M Turner-jointer | Podiatrist | 4101 Max St, Moss Point, MS 39563-5555 | 2009-04-13 |
| Find all providers with the same taxonomy | ||||
Please comment or provide details below to improve the information on DR. BRIAN EDWARD SHOCKLEY.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.