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General NPI Number Information
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NPI Number | 1982638466
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Entity Type | Individual
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Provider Name | MARTIN ENGWALL SHELINE MD
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Gender | Male
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Dates
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Enumeration Date | 07/10/2006
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Last Update Date | 10/06/2011
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Provider Practice Location Address
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Address Line | 527 N. PALO ALTO AVE
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City | PANAMA CITY
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State | FL
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Zip | 32401-3639
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Country | US
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Telephone | 850-747-4905
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Fax | 850-747-4907
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Provider Business Mailing Address
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Address Line | P.O. BOX 1770
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City | PANAMA CITY
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State | FL
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Zip | 32402-1770
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Country | US
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Telephone | 850-747-4905
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Fax | 850-747-4907
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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 | 2085R0204X
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Taxonomy Name | Vascular & Interventional Radiology Physician
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License Number | 34710
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | ME109093
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 2085R0204X
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Taxonomy Name | Vascular & Interventional Radiology Physician
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License Number | ME109093
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License Number State | FL
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