MEDICARE: DR. DAVID SHIELDS LESSER M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	00025581	AL

General Provider Information

NPI Number	:	1427036516
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DAVID SHIELDS LESSER M.D.

Provider Business Mailing Address
First Line	:	7003 LOCH ST
Second Line	:
City	:	PEARL CITY
State	:	HI
Zip	:	96782-3450
Country	:	US
Telephone Number	:	850-221-0560
Fax Number	:	850-471-1855

Provider Business Practice Location Address
First Line	:	7003 LOCH ST
Second Line	:
City	:	PEARL CITY
State	:	HI
Zip	:	96782-3450
Country	:	US
Telephone Number	:	850-221-0560
Fax Number	:	850-471-1855

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/09/2006
Last Update Date	:	07/08/2007

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