Healthcare Provider Details

I. General information

NPI: 1285626762
Provider Name (Legal Business Name): JOHN H SHIM MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/19/2005
Last Update Date: 02/09/2021
Certification Date: 01/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

309 STATE STREET EAST SUITE 201
OLDSMAR FL
34677
US

IV. Provider business mailing address

PO BOX 2220
OLDSMAR FL
34677-7220
US

V. Phone/Fax

Practice location:
  • Phone: 813-814-9251
  • Fax: 813-814-9261
Mailing address:
  • Phone: 813-814-9251
  • Fax: 813-814-9261

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberME0063979
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: