Provider Demographics
NPI:1558357459
Name:SHAGRIN, JONATHAN MALCOLM (MD)
Entity Type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:MALCOLM
Last Name:SHAGRIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:225 HOURGLASS WAY
Mailing Address - Street 2:301
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34242-1676
Mailing Address - Country:US
Mailing Address - Phone:941-312-9662
Mailing Address - Fax:941-349-9502
Practice Address - Street 1:225 HOURGLASS WAY
Practice Address - Street 2:301
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34242-1676
Practice Address - Country:US
Practice Address - Phone:941-312-9662
Practice Address - Fax:941-349-9502
Is Sole Proprietor?:No
Enumeration Date:2005-09-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME89363207LC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LC0200XAllopathic & Osteopathic PhysiciansAnesthesiologyCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLU2836AMedicare ID - Type Unspecified
FLA59249Medicare UPIN