Basic Information
| Provider Information | |||||||||
| NPI: | 1518940469 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SHOOK | ||||||||
| FirstName: | MARSHALL | ||||||||
| MiddleName: | SHANNON | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | II | ||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 955 RIBAUT RD | ||||||||
| Address2: | BMAC CREDENTIALING | ||||||||
| City: | BEAUFORT | ||||||||
| State: | SC | ||||||||
| PostalCode: | 299025441 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8435225674 | ||||||||
| FaxNumber: | 8435225678 | ||||||||
| Practice Location | |||||||||
| Address1: | BEAUFORT MEMORIAL HEART SPECIALISTS | ||||||||
| Address2: | 300 MIDTOWN DRIVE | ||||||||
| City: | BEAUFORT | ||||||||
| State: | SC | ||||||||
| PostalCode: | 299065200 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8437700404 | ||||||||
| FaxNumber: | 8442959872 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/23/2005 | ||||||||
| LastUpdateDate: | 07/25/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | ME102688 | FL | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | 42970 | TN | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | 24622 | SC | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207RC0000X | 24622 | SC | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease |
ID Information
| ID | Type | State | Issuer | Description | 246228 | 05 | SC | MEDICAID |