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General NPI Number Information
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NPI Number | 1790784106
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Entity Type | Individual
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Provider Name | JAMES W SHORE MD
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Gender | Male
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Dates
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Enumeration Date | 07/18/2005
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Last Update Date | 05/26/2021
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Provider Practice Location Address
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Address Line | 117 KENNEDY DR
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City | MARTIN
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State | TN
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Zip | 38237-3394
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Country | US
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Telephone | 731-587-9511
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Fax | 877-309-6416
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Provider Business Mailing Address
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Address Line | 117 KENNEDY DR
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City | MARTIN
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State | TN
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Zip | 38237-3309
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Country | US
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Telephone | 731-587-9511
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Fax | 877-309-6416
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | MD5113
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License Number State | TN
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