Provider Demographics
NPI:1164678199
Name:SHIRLEY & ASSOCIATES CHARTERED
Entity Type:Organization
Organization Name:SHIRLEY & ASSOCIATES CHARTERED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:D
Authorized Official - Last Name:SHIRLEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:904-398-2010
Mailing Address - Street 1:3728 PHILLIPS HWY
Mailing Address - Street 2:SUITE 214A
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32207-9300
Mailing Address - Country:US
Mailing Address - Phone:904-398-2010
Mailing Address - Fax:904-398-7154
Practice Address - Street 1:3728 PHILLIPS HWY
Practice Address - Street 2:SUITE 214A
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32207-9300
Practice Address - Country:US
Practice Address - Phone:904-398-2010
Practice Address - Fax:904-398-7154
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-11
Last Update Date:2008-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 21555207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLD52561Medicare UPIN