Individual
MR. SHANE ANGUS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
A.A.
Contact information
Practice address
1551 W BAY DR, LARGO, FL 33770-2209
(727) 581-8767
Mailing address
1551 W BAY DR, LARGO, FL 33770-2209
(727) 581-8767
Taxonomy
Speciality
Code
Description
License number
State
367H00000X
Anesthesiologist Assistant
Primary
AA4
FL
Other
Enumeration date
06/19/2006
Last updated
07/08/2007
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