Provider Demographics
NPI:1093718298
Name:SHIRES, DANA L JR (MD)
Entity Type:Individual
Prefix:DR
First Name:DANA
Middle Name:L
Last Name:SHIRES
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 BAYSHORE BLVD
Mailing Address - Street 2:STE 600
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33606-2756
Mailing Address - Country:US
Mailing Address - Phone:813-251-8017
Mailing Address - Fax:813-251-0096
Practice Address - Street 1:409 BAYSHORE BLVD
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33606-2707
Practice Address - Country:US
Practice Address - Phone:813-251-8017
Practice Address - Fax:813-251-0096
Is Sole Proprietor?:No
Enumeration Date:2005-05-23
Last Update Date:2008-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0009931207RN0300X
GA009609207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL038852100Medicaid
FLD53697Medicare UPIN
FL29747YMedicare ID - Type Unspecified