Provider Demographics
NPI:1326195504
Name:SHIPLEY, JAMES ROBERT (DPM)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:ROBERT
Last Name:SHIPLEY
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:367 S ANDY GRIFFITH PKWY STE 200
Mailing Address - Street 2:
Mailing Address - City:MOUNT AIRY
Mailing Address - State:NC
Mailing Address - Zip Code:27030-4010
Mailing Address - Country:US
Mailing Address - Phone:336-443-9190
Mailing Address - Fax:336-745-5936
Practice Address - Street 1:367 S ANDY GRIFFITH PKWY STE 200
Practice Address - Street 2:
Practice Address - City:MOUNT AIRY
Practice Address - State:NC
Practice Address - Zip Code:27030-4010
Practice Address - Country:US
Practice Address - Phone:336-443-9190
Practice Address - Fax:336-745-5936
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-03
Last Update Date:2021-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC519213ES0103X, 213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Multi-Specialty
No213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1326195504Medicaid
NCNCA058B699OtherMEDICARE PTAN
NCP01459103OtherRAILROAD MEDICARE