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NPI Code Detail

MEDICARE: JOEL K SHUGAR MD PA

MEDICARE: JOEL K SHUGAR MD PA
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
1152W00000XOptometristOPC3983FL

General Provider Information

NPI Number : 1699887372
Entity Type Code : Organization
Provider Name (Legal Business Name) : JOEL K SHUGAR MD PA
Provider Business Mailing Address
First Line : 555 N BYRON BUTLER PKWY
Second Line :
City : PERRY
State : FL
Zip : 32347-2315
Country : US
Telephone Number : 850-584-2778
Fax Number : 850-584-2790
Provider Business Practice Location Address
First Line : 555 N BYRON BUTLER PKWY
Second Line :
City : PERRY
State : FL
Zip : 32347-2315
Country : US
Telephone Number : 850-584-2778
Fax Number : 850-584-2790
Authorized Official
Title or Position : MANAGING EMPLOYEE/CEO
Name : MR. CHARLES SCOTT KEELER
Credential :
Telephone Number : 850-584-2778
Provider Enumeration Date : 08/31/2006
Last Update Date : 08/07/2008

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