Healthcare Provider Details

I. General information

NPI: 1588767529
Provider Name (Legal Business Name): WILLIAM MITCHELL SHUFFETT JR. MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/06/2006
Last Update Date: 02/17/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

131 ORANGE AVE
CORONADO CA
92118-1408
US

IV. Provider business mailing address

131 ORANGE AVE
CORONADO CA
92118-1408
US

V. Phone/Fax

Practice location:
  • Phone: 619-437-4449
  • Fax: 619-437-0167
Mailing address:
  • Phone: 619-437-4449
  • Fax: 619-437-0167

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License NumberG37431
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: