MEDICARE: DR. ERIC R SHIVES 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	207Q00000X	Family Medicine Physician	272179	NY

General Provider Information

NPI Number	:	1982751533
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ERIC R SHIVES MD

Provider Business Mailing Address
First Line	:	1991 BALSLEY RD
Second Line	:
City	:	SENECA FALLS
State	:	NY
Zip	:	13148-6725
Country	:	US
Telephone Number	:	315-539-9229
Fax Number	:	315-539-0940

Provider Business Practice Location Address
First Line	:	1991 BALSLEY RD
Second Line	:
City	:	SENECA FALLS
State	:	NY
Zip	:	13148-6725
Country	:	US
Telephone Number	:	315-539-9229
Fax Number	:	315-539-0940

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

Provider Enumeration Date	:	01/05/2007
Last Update Date	:	11/25/2013

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