Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208800000X | Urologist | ME103638 | FL |
NPI | 1003851957 |
---|---|
Provider Name | Dr. Stanley H Shrom |
First Address | Clearwater, FL 33757 |
Second Address | Lakeland, FL 33812-4323 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/06/2006 |
Last Update Date | 02/06/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000891800 | (05) | FL |
29218 | BLUE CROSS BLUE SHIELD (01) | FL |
B36369 | (02) | FL |
P00723081 | RAILROAD MEDICARE (01) | FL |