Basic Information
| Provider Information | |||||||||
| NPI: | 1093783672 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SHEFFIELD | ||||||||
| FirstName: | PAUL | ||||||||
| MiddleName: | E | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 23666 | ||||||||
| Address2: | |||||||||
| City: | JACKSON | ||||||||
| State: | MS | ||||||||
| PostalCode: | 392253666 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6012004749 | ||||||||
| FaxNumber: | 6012005929 | ||||||||
| Practice Location | |||||||||
| Address1: | 969 LAKELAND DR | ||||||||
| Address2: | |||||||||
| City: | JACKSON | ||||||||
| State: | MS | ||||||||
| PostalCode: | 392164606 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6012003131 | ||||||||
| FaxNumber: | 6012003109 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/09/2006 | ||||||||
| LastUpdateDate: | 09/05/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 09184 | MS | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 753068151 | 01 | MS | 1ST CHOICE | OTHER | 753068151 | 01 | MS | MS PHYSICIANS CARE NETWOR | OTHER | P0026770 | 01 | MS | RR MEDICARE | OTHER | 00113398 | 05 | MS | MEDICAID | 753068151 | 01 | MS | MS HEALTH PARTNERS | OTHER | 4274983 | 01 | MS | AETNA | OTHER | 753068151008 | 01 | MS | TRICARE | OTHER | 168390702 | 01 | MS | US DEPT OF LABOR | OTHER |