Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207KA0200X | Allergist | D60557 | MD |
N | 207R00000X | Internist | D0060557 | MD |
N | 111NI0900X | Internist | D0060557 | MD |
NPI | 1477544344 |
---|---|
Provider Name | Leo L Shue |
First Address | Rockville, MD 20853-1419 |
Second Address | Rockville, MD 20850-6211 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/10/2005 |
Last Update Date | 02/09/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
H98737 | (02) |