# PHILIP LEROY SHETTLE

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** Yes

## Provider details

- **NPI number:** 1427056548
- **Gender:** Man
- **Credential:** D.O.

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207W00000X | Ophthalmology Physician | 29764 | MO | — |
| 207W00000X | Ophthalmology Physician | OS 1590 | FL | Yes |

## Other

- **Enumeration date:** 07/12/2005
- **Last updated:** 08/25/2011

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 046607700 | — | FL |
| 01 | — | 185886390 | RAILROAD MEDICARE | FL |
| 01 | — | 81475 | BCBS OF FLORIDA | FL |