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General NPI Number Information
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NPI Number | 1063643856
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Entity Type | Individual
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Provider Name | JACOB WAYNE SHIPLEY M.D.
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Gender | Male
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Dates
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Enumeration Date | 07/28/2009
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Last Update Date | 03/08/2021
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Provider Practice Location Address
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Address Line | 126 E CHURCH ST STE 2400
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City | SOMERSET
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State | PA
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Zip | 15501
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Country | US
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Telephone | 814-443-5800
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Fax | 814-443-5499
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Provider Business Mailing Address
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Address Line | 329 S PLEASANT AVE
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City | SOMERSET
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State | PA
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Zip | 15501-2262
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Country | US
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Telephone | 814-445-3575
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Fax | 814-445-5700
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | MD450197
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 207LP2900X
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Taxonomy Name | Pain Medicine (Anesthesiology) Physician
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License Number | 35.123054
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License Number State | OH
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Taxonomy #3
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Taxonomy Code | 208VP0000X
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Taxonomy Name | Pain Medicine Physician
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License Number | MD450197
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License Number State | PA
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