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General NPI Number Information
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NPI Number | 1639137326
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Entity Type | Individual
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Provider Name | BRIAN J SHIPLE DO
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Gender | Male
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Dates
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Enumeration Date | 05/02/2006
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Last Update Date | 12/04/2025
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Provider Practice Location Address
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Address Line | 9351 CORKSCREW RD STE 103
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City | ESTERO
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State | FL
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Zip | 33928-6801
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Country | US
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Telephone | 239-687-3199
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Fax | 855-398-9437
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Provider Business Mailing Address
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Address Line | 525 COUNTRY CLUB DR
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City | WILMINGTON
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State | DE
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Zip | 19803-2430
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Country | US
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Telephone | 302-354-4895
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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 | 207QS0010X
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Taxonomy Name | Sports Medicine (Family Medicine) Physician
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License Number | OS17841
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 207QS0010X
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Taxonomy Name | Sports Medicine (Family Medicine) Physician
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License Number | OS077302-E
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License Number State | PA
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