Organization
LEE SHETTLE DO PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. PHILIP LEE SHETTLE DO (OWNER)
(727) 674-2500
Entity
Organization
Contact information
Practice address
13113 66TH ST N, LARGO, FL 33773-1812
(727) 674-2500
(727) 674-2550
Mailing address
13113 66TH ST N, LARGO, FL 33773-1812
(727) 674-2500
(727) 674-2550
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
OS6621
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
180045006
RAILROAD MEDICARE
FL
05
—
378381200
—
FL
01
—
80884
BCBS OF FLORIDA
FL
Enumeration date
02/28/2011
Last updated
12/16/2020
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