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General NPI Number Information
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NPI Number | 1285733204
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Entity Type | Individual
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Provider Name | LEROY SHOUSE MD
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Gender | Male
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Dates
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Enumeration Date | 09/22/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1 W MCDONALD PKWY STE 1B
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City | MAYSVILLE
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State | KY
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Zip | 41056-1138
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Country | US
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Telephone | 606-564-3351
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Fax | 606-564-5631
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Provider Business Mailing Address
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Address Line | 1 W MCDONALD PKWY STE 1B M
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City | MAYSVILLE
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State | KY
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Zip | 41056-1138
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Country | US
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Telephone | 606-564-3351
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Fax | 606-564-5631
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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 | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | 18295
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License Number State | KY
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