Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Y00000X | Otolaryngologist (ENT Doctor) | ME0065243 | FL |
N | 207YP0228X | Pediatric Otolaryngology | ME0065243 | FL |
NPI | 1639128416 |
---|---|
Provider Name | Roger Marks Shea |
First Address | Sarasota, FL 34233 |
Second Address | Sarasota, FL 34233 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/05/2006 |
Last Update Date | 17/09/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
379122000 | (05) | FL |
G16320 | (02) |