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General NPI Number Information
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NPI Number | 1780981779
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Entity Type | Organization
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Legal Business Name | LEE SHETTLE DO PA
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Dates
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Enumeration Date | 02/28/2011
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Last Update Date | 12/16/2020
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Provider Practice Location Address
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Address Line | 13113 66TH ST N
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City | LARGO
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State | FL
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Zip | 33773-1812
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Country | US
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Telephone | 727-674-2500
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Fax | 727-674-2550
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Provider Business Mailing Address
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Address Line | 13113 66TH ST N
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City | LARGO
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State | FL
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Zip | 33773-1812
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Country | US
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Telephone | 727-674-2500
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Fax | 727-674-2550
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Authorized Official
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Title or Position | OWNER
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Name | DR. PHILIP LEE SHETTLE
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Credential | DO
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Telephone | 727-674-2500
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | OS6621
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License Number State | FL
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