Healthcare Provider Details

I. General information

NPI: 1871612168
Provider Name (Legal Business Name): JAMES ROBERT SHIRE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/28/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6151 SHALLOWFORD RD SUITE 101
CHATTANOOGA TN
37421-1616
US

IV. Provider business mailing address

6151 SHALLOWFORD RD SUITE 101
CHATTANOOGA TN
37421-1616
US

V. Phone/Fax

Practice location:
  • Phone: 423-870-3223
  • Fax: 423-870-3276
Mailing address:
  • Phone: 423-870-3223
  • Fax: 423-870-3276

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2082S0099X
TaxonomyPlastic Surgery Within the Head and Neck (Plastic Surgery) Physician
License Number29775
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: