Provider Demographics
NPI:1710089024
Name:FRANCKLE, CORNELIUS SHAW (MD)
Entity Type:Individual
Prefix:DR
First Name:CORNELIUS
Middle Name:SHAW
Last Name:FRANCKLE
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 1:106-4TH ST E
Mailing Address - Street 2:
Mailing Address - City:ST. PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33715-2241
Mailing Address - Country:US
Mailing Address - Phone:727-867-2433
Mailing Address - Fax:727-864-3115
Practice Address - Street 1:1609 PASADENA AVE S
Practice Address - Street 2:SUITE 1E
Practice Address - City:SOUTH PASADENA
Practice Address - State:FL
Practice Address - Zip Code:33707-4565
Practice Address - Country:US
Practice Address - Phone:727-341-7870
Practice Address - Fax:727-341-7758
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-05
Last Update Date:2008-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0022334207PE0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207PE0005XAllopathic & Osteopathic PhysiciansEmergency MedicineUndersea and Hyperbaric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL059759700Medicaid
FL930123645OtherRR MEDICARE
FLD64434Medicare UPIN
FL52888Medicare PIN