Healthcare Provider Details

I. General information

NPI: 1639137326
Provider Name (Legal Business Name): BRIAN J SHIPLE DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/02/2006
Last Update Date: 12/04/2025
Certification Date: 12/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9351 CORKSCREW RD STE 103
ESTERO FL
33928-6801
US

IV. Provider business mailing address

525 COUNTRY CLUB DR
WILMINGTON DE
19803-2430
US

V. Phone/Fax

Practice location:
  • Phone: 239-687-3199
  • Fax: 855-398-9437
Mailing address:
  • Phone: 302-354-4895
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License NumberOS17841
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License NumberOS077302-E
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: