MEDICARE: TODD LARRY SHOVER D.O.

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	207Q00000X	Family Medicine Physician	3408	IA
2	207P00000X	Emergency Medicine Physician	3408	IA

General Provider Information

NPI Number	:	1558364240
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TODD LARRY SHOVER D.O.

Provider Business Mailing Address
First Line	:	312 9TH ST SW
Second Line	:
City	:	WAVERLY
State	:	IA
Zip	:	50677-2929
Country	:	US
Telephone Number	:	319-352-4120
Fax Number	:

Provider Business Practice Location Address
First Line	:	312 9TH ST SW
Second Line	:
City	:	WAVERLY
State	:	IA
Zip	:	50677-2929
Country	:	US
Telephone Number	:	319-352-4120
Fax Number	:

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

Provider Enumeration Date	:	05/27/2005
Last Update Date	:	11/16/2007

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Directions to “ TODD LARRY SHOVER D.O.” Practice Location

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