MEDICARE: MR. WILLIAM F SHIPMAN III P A

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	PA1658	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1609801257	OTHER		GROUP NPI

General Provider Information

NPI Number	:	1548721343
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. WILLIAM F SHIPMAN III P A

Provider Business Mailing Address
First Line	:	PO BOX 18379
Second Line	:
City	:	PANAMA CITY BEACH
State	:	FL
Zip	:	32417-8379
Country	:	US
Telephone Number	:	850-588-3880
Fax Number	:	850-914-7045

Provider Business Practice Location Address
First Line	:	11111 PANAMA CITY BEACH PKWY
Second Line	:
City	:	PANAMA CITY BEACH
State	:	FL
Zip	:	32407-2448
Country	:	US
Telephone Number	:	850-769-0329
Fax Number	:	850-914-7045

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/26/2019
Last Update Date	:	03/26/2019

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