Organization
VICTOR A. SHADA, D.O., P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. VICTOR ANTHONY SHADA D.O. (OWNER)
(931) 484-4560
Entity
Organization
Contact information
Practice address
396 S MAIN ST, CROSSVILLE, TN 38555-5092
(931) 484-4560
(931) 484-1480
Mailing address
PO BOX 887, CROSSVILLE, TN 38557-0887
(931) 484-4560
(931) 484-1480
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
1424
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3306875
—
TN
Enumeration date
11/20/2007
Last updated
07/09/2010
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