Provider Demographics
NPI:1083689772
Name:SHALLOWAY, LESTER FREDERICK (MD)
Entity Type:Individual
Prefix:DR
First Name:LESTER
Middle Name:FREDERICK
Last Name:SHALLOWAY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:10095 N KENDALL DR
Mailing Address - Street 2:SUITE 102
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33176-1797
Mailing Address - Country:US
Mailing Address - Phone:305-595-5455
Mailing Address - Fax:305-595-5227
Practice Address - Street 1:10095 N KENDALL DR
Practice Address - Street 2:SUITE 102
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33176-1797
Practice Address - Country:US
Practice Address - Phone:305-595-5455
Practice Address - Fax:305-595-5227
Is Sole Proprietor?:No
Enumeration Date:2006-02-17
Last Update Date:2022-10-20
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FL39095207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLD63988Medicare UPIN
FLD63988Medicare UPIN