Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204D00000X | Neuromusculoskeletal Medicine (NMM) | UO2277 | FL |
N | 207R00000X | Internist | MA244984 | MA |
N | 111NI0900X | Internist | MA244984 | MA |
N | 207R00000X | Internist | UO2277 | FL |
N | 111NI0900X | Internist | UO2277 | FL |
NPI | 1538470877 |
---|---|
Provider Name | Shawn Patrick St. Marie |
First Address | Orlando, FL 32814-6416 |
Second Address | Orlando, FL 32814-6416 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/07/2010 |
Last Update Date | 15/03/2021 |