Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207K00000X | Allergist & Immunologist | ME0073924 | FL |
NPI | 1194795807 |
---|---|
Provider Name | Dr. Thomas J Shen |
First Address | Leesburg, FL 34788-3751 |
Second Address | Leesburg, FL 34788-3751 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/01/2006 |
Last Update Date | 17/03/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
252644100 | (05) | FL |
41838 | BLUE CROSS AND BLUESHIELD (01) | FL |
5923541 | AETNA (01) | FL |
G23772 | (02) | FL |