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General NPI Number Information
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NPI Number | 1902852239
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Entity Type | Individual
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Provider Name | JAMIE DAVID SHUTTER MD
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Gender | Male
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Dates
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Enumeration Date | 05/26/2006
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Last Update Date | 12/19/2024
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Provider Practice Location Address
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Address Line | 6250 N DURANGO DR
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City | LAS VEGAS
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State | NV
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Zip | 89149-3916
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Country | US
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Telephone | 702-342-9990
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Fax | 702-485-2372
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Provider Business Mailing Address
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Address Line | PO BOX 25317 #207
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City | TAMPA
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State | FL
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Zip | 33622-5317
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Country | US
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Telephone | 813-286-0033
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Fax | 813-282-1806
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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 | 207ZP0102X
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Taxonomy Name | Anatomic Pathology & Clinical Pathology Physician
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License Number | D0091999
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License Number State | MD
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Taxonomy #2
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Taxonomy Code | 207ZP0102X
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Taxonomy Name | Anatomic Pathology & Clinical Pathology Physician
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License Number | 2011-00052
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License Number State | NC
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Taxonomy #3
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Taxonomy Code | 207ZP0102X
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Taxonomy Name | Anatomic Pathology & Clinical Pathology Physician
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License Number | MD036095
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License Number State | DC
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Taxonomy #4
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Taxonomy Code | 207ZP0102X
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Taxonomy Name | Anatomic Pathology & Clinical Pathology Physician
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License Number | R9435
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License Number State | TX
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Taxonomy #5
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Taxonomy Code | 207ZP0102X
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Taxonomy Name | Anatomic Pathology & Clinical Pathology Physician
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License Number | ME 98596
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License Number State | FL
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Taxonomy #6
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Taxonomy Code | 207ZP0102X
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Taxonomy Name | Anatomic Pathology & Clinical Pathology Physician
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License Number | 25728
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License Number State | NV
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