Individual
PHILIP LEROY SHETTLE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
670 CLEARWATER LARGO RD N, SUITE A, LARGO, FL 33770-2377
(727) 581-8755
(727) 581-8756
Mailing address
670 CLEARWATER LARGO RD N, SUITE A, LARGO, FL 33770-2377
(727) 581-8755
(727) 581-8756
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
29764
MO
207W00000X
Ophthalmology Physician
Primary
OS 1590
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
046607700
—
FL
01
—
185886390
RAILROAD MEDICARE
FL
01
—
81475
BCBS OF FLORIDA
FL
Enumeration date
07/12/2005
Last updated
08/25/2011
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