Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204C00000X | Sports Medicine Doctor | D0118 | AL |
N | 208100000X | Physical Medicine & Rehabilitation Doctor | D0118 | AL |
NPI | 1144284951 |
---|---|
Provider Name | Dr. Robert D Shedden |
First Address | Dothan, AL 36303-2963 |
Second Address | Dothan, AL 36303-2963 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/04/2006 |
Last Update Date | 22/03/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
22334 | GEORGIA STATE LICENSE (01) | GA |
C70397 | (02) | AL |
D0118 | ALABAMA LICENSE NUMBER (01) | AL |