Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Y00000X | Otolaryngologist (ENT Doctor) | 00003702 | AL |
NPI | 1033147822 |
---|---|
Provider Name | Mr. James Edgar Shotts JR. |
First Address | Tuscaloosa, AL 35406-2283 |
Second Address | Tuscaloosa, AL 35406-2283 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/06/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
C71281 | (02) |