Individual
DR. MARTIN ENGWALL SHELINE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
527 N. PALO ALTO AVE, PANAMA CITY, FL 32401-3639
(850) 747-4905
(850) 747-4907
Mailing address
P.O. BOX 1770, PANAMA CITY, FL 32402-1770
(850) 747-4905
(850) 747-4907
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
ME109093
FL
2085R0204X
Vascular & Interventional Radiology Physician
34710
GA
2085R0204X
Vascular & Interventional Radiology Physician
ME109093
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003672200
—
FL
01
—
14E53
BCBS
FL
Enumeration date
07/10/2006
Last updated
10/06/2011
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