Provider Demographics
NPI:1134106354
Name:SHALL, JEFFREY F (MD)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:F
Last Name:SHALL
Suffix:
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:PO BOX 932127
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44193-0008
Mailing Address - Country:US
Mailing Address - Phone:216-369-2830
Mailing Address - Fax:
Practice Address - Street 1:6701 ROCKSIDE RD STE 350
Practice Address - Street 2:
Practice Address - City:INDEPENDENCE
Practice Address - State:OH
Practice Address - Zip Code:44131-2351
Practice Address - Country:US
Practice Address - Phone:216-369-2830
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-29
Last Update Date:2021-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35058254207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0744958Medicaid
OHP00381215OtherRR MEDICARE
OHP00381215OtherRR MEDICARE
OHH038000Medicare PIN
OH0744958Medicaid