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General NPI Number Information
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NPI Number | 1598768210
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Entity Type | Individual
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Provider Name | DUDLEY ALAN SHAW P.A
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Gender | Male
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Dates
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Enumeration Date | 05/27/2005
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 6 OFFICE PARK DR
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City | PALM COAST
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State | FL
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Zip | 32137-3808
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Country | US
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Telephone | 386-447-6615
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Fax |
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Provider Business Mailing Address
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Address Line | 2312 S DAYTONA AVE
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City | FLAGLER BEACH
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State | FL
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Zip | 32136-4031
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Country | US
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Telephone |
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Fax |
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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 | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | PA2468
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License Number State | FL
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