Healthcare Provider Details

I. General information

NPI: 1194070268
Provider Name (Legal Business Name): DAVID SHUTER MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/16/2012
Last Update Date: 07/16/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

730 W INDIANTOWN RD
JUPITER FL
33458-7507
US

IV. Provider business mailing address

730 W INDIANTOWN RD
JUPITER FL
33458-7507
US

V. Phone/Fax

Practice location:
  • Phone: 561-743-0244
  • Fax: 561-743-4250
Mailing address:
  • Phone: 561-743-0244
  • Fax: 561-743-4250

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License NumberME-0056949
License Number StateFL

VIII. Authorized Official

Name: DR. ISRAEL DAVID SHUTER
Title or Position: PRESIDENT/OWNER
Credential: MD
Phone: 561-743-0244