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Organization
SHIRLEY A ICE MD PA
Active
Organization
SHIRLEY A ICE MD PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SHIRLEY A ICE MD (PRESIDENT)
(352) 465-2449
Entity
Organization
Contact information
Practice address
19204 E PENNSYLVANIA AVE, DUNNELLON, FL 34432-6111
(352) 465-2449
(352) 465-2451
Mailing address
19204 E PENNSYLVANIA AVE, DUNNELLON, FL 34432-6111
(352) 465-2449
(352) 465-2451
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
ME0071113
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2532203400
—
FL
Enumeration date
06/24/2008
Last updated
11/02/2010
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