Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RC0000X | Internist - Cardiovascular Disease | 62453 | WI |
Y | 207RC0000X | Internist - Cardiovascular Disease | 77557 | GA |
N | 207U00000X | Nuclear Medicine Specialist | 223248 | MA |
N | 207U00000X | Nuclear Medicine Specialist | 34402 | IA |
NPI | 1043257090 |
---|---|
Provider Name | Shayne R Squires |
First Address | Atlanta, GA 30339-6151 |
Second Address | Monroe, GA 30655-3209 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/05/2006 |
Last Update Date | 13/01/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1043257090 | (05) | IA |