Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XX0004X | Foot and Ankle Orthopaedic Surgeon | PO1469 | FL |
NPI | 1124090501 |
---|---|
Provider Name | Mr. Stanley S Shama |
First Address | Temple Terrace, FL 33617 |
Second Address | Temple Terrace, FL 33617-5512 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/02/2006 |
Last Update Date | 16/07/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
058732000 | (05) | FL |
T55543 | (02) |