Provider Demographics
NPI:1164703427
Name:JOHN L. SHOVER D.O., P.A.
Entity Type:Organization
Organization Name:JOHN L. SHOVER D.O., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:LINDSAY
Authorized Official - Last Name:SHOVER
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:727-541-4458
Mailing Address - Street 1:8133 54TH AVE N
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33709-1001
Mailing Address - Country:US
Mailing Address - Phone:727-541-4458
Mailing Address - Fax:727-546-6663
Practice Address - Street 1:8133 54TH AVE N
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33709-1001
Practice Address - Country:US
Practice Address - Phone:727-541-4458
Practice Address - Fax:727-546-6663
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-31
Last Update Date:2011-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL057509700Medicaid
FL82098Medicare PIN
FL057509700Medicaid