Healthcare Provider Details

I. General information

NPI: 1295888733
Provider Name (Legal Business Name): PAUL B SHREWSBURY PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/19/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 SAINT CHRISTOPHER DR
ASHLAND KY
41101
US

IV. Provider business mailing address

800 SAINT CHRISTOPHER DR
ASHLAND KY
41101
US

V. Phone/Fax

Practice location:
  • Phone: 606-836-9613
  • Fax: 606-836-0026
Mailing address:
  • Phone: 606-836-9613
  • Fax: 606-836-0026

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA019
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: