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Individual
PHILIP LEE SHETTLE
Active
Individual
PHILIP LEE SHETTLE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.O.
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
32591
CO
207W00000X
Ophthalmology Physician
5101010879
MI
207W00000X
Ophthalmology Physician
Primary
OS 6621
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
180045006
RAILROAD MEDICARE
FL
05
—
378381200
—
FL
01
—
80884
BCBS OF FLORIDA
FL
Enumeration date
07/12/2005
Last updated
12/16/2020
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