Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207P00000X | Emergency Physician | OS12335 | FL |
NPI | 1003118282 |
---|---|
Provider Name | Bryce Shedlock |
First Address | St Petersburg, FL 33710-1629 |
Second Address | St Petersburg, FL 33710-1629 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/11/2010 |
Last Update Date | 13/12/2016 |