| Doctor Name: | JASON LEE SHIVES |
| NPI Number: | 1083942338 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | MD |
| License Number: | |
| Business Practice Address: | 102 Shelby Speights Dr Purvis, MS - 394754151 |
| Business Phone Number: | 6017948065 |
| Business Fax Number: | 6017945650 |
| Mailing Address: | 102 Shelby Speights Dr, PURVIS |
| State: | MS |
| Postal Code: | 394754151 |
| Phone Number: | 6017948065 |
| Fax Number: | 6017945650 |
| NPI Enumeration Date: | 11/25/2009 |
| NPI Last Update Date: | 01/14/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 390200000X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | |
| Taxonomy Type: | Student, Health Care |
| Taxonomy Classification: | Student in an Organized Health Care Education/Training Program |
| Taxonomy Specialization: | |
| Taxonomy Definition: | An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care. |