Healthcare Provider Details

I. General information

NPI: 1659321313
Provider Name (Legal Business Name): GARY A. SHEARER MD LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/11/2006
Last Update Date: 04/16/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7210 TURFWAY RD
FLORENCE KY
41042-5117
US

IV. Provider business mailing address

7210 TURFWAY RD
FLORENCE KY
41042-5117
US

V. Phone/Fax

Practice location:
  • Phone: 859-746-2880
  • Fax: 859-746-2881
Mailing address:
  • Phone: 859-746-2880
  • Fax: 859-746-2880

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number StateKY
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number StateKY
# 4
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number StateKY
# 5
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number StateKY
# 6
Primary TaxonomyN
Taxonomy Code2084P0015X
TaxonomyPsychosomatic Medicine Physician
License Number0629801
License Number StateKY
# 7
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number0629801
License Number StateKY
# 8
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number StateKY

VIII. Authorized Official

Name: DR. GARY A SHEARER
Title or Position: PRESIDENT
Credential: M.D.
Phone: 859-746-2880