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NPI Code Detail

MEDICARE: MR. DUDLEY ALAN SHAW P.A

MEDICARE: MR. DUDLEY ALAN SHAW 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
1363AM0700XMedical Physician AssistantPA2468FL

General Provider Information

NPI Number : 1598768210
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. DUDLEY ALAN SHAW P.A
Provider Business Mailing Address
First Line : 2312 S DAYTONA AVE
Second Line :
City : FLAGLER BEACH
State : FL
Zip : 32136-4031
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 6 OFFICE PARK DR
Second Line :
City : PALM COAST
State : FL
Zip : 32137-3808
Country : US
Telephone Number : 386-447-6615
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/27/2005
Last Update Date : 07/08/2007

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