Healthcare Provider Details

I. General information

NPI: 1487614111
Provider Name (Legal Business Name): STEVE SHIRLEY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/25/2006
Last Update Date: 08/22/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3599 UNIVERSITY BLVD S BUILDING 300
JACKSONVILLE FL
32216-4252
US

IV. Provider business mailing address

3599 UNIVERSITY BLVD S BUILDING 300
JACKSONVILLE FL
32216-4252
US

V. Phone/Fax

Practice location:
  • Phone: 904-399-5550
  • Fax: 904-346-4334
Mailing address:
  • Phone: 904-399-5550
  • Fax: 904-346-4334

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License NumberME39237
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberME39237
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: