Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN0400X | Neurology | CH0005590 | FL |
NPI | 1902958648 |
---|---|
Provider Name | Dr. Clifford Michael Shooker |
First Address | Mount Dora, FL 32757-2814 |
Second Address | Mount Dora, FL 32757-2814 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/01/2007 |
Last Update Date | 08/07/2007 |