MEDICARE: DR. JAMIE DAVID SHUTTER MD

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	207ZP0102X	Anatomic Pathology & Clinical Pathology Physician	D0091999	MD
2	207ZP0102X	Anatomic Pathology & Clinical Pathology Physician	2011-00052	NC
3	207ZP0102X	Anatomic Pathology & Clinical Pathology Physician	MD036095	DC
4	207ZP0102X	Anatomic Pathology & Clinical Pathology Physician	R9435	TX
5	207ZP0102X	Anatomic Pathology & Clinical Pathology Physician	ME 98596	FL
6	207ZP0102X	Anatomic Pathology & Clinical Pathology Physician	25728	NV

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	162VJ	OTHER	NC	BCBSNC
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	01299	OTHER	FL	BLUE CROSS BLUE SHIELD
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1902852239
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JAMIE DAVID SHUTTER MD

Provider Business Mailing Address
First Line	:	PO BOX 25317
Second Line	:	#207
City	:	TAMPA
State	:	FL
Zip	:	33622-5317
Country	:	US
Telephone Number	:	813-286-0033
Fax Number	:	813-282-1806

Provider Business Practice Location Address
First Line	:	6250 N DURANGO DR
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89149-3916
Country	:	US
Telephone Number	:	702-342-9990
Fax Number	:	702-485-2372

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

Provider Enumeration Date	:	05/26/2006
Last Update Date	:	12/19/2024

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Directions to “ DR. JAMIE DAVID SHUTTER MD” Practice Location

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