Provider Demographics
NPI:1790784106
Name:SHORE, JAMES W (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:W
Last Name:SHORE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:117 KENNEDY DR
Mailing Address - Street 2:
Mailing Address - City:MARTIN
Mailing Address - State:TN
Mailing Address - Zip Code:38237-3309
Mailing Address - Country:US
Mailing Address - Phone:731-587-9511
Mailing Address - Fax:877-309-6416
Practice Address - Street 1:117 KENNEDY DR
Practice Address - Street 2:
Practice Address - City:MARTIN
Practice Address - State:TN
Practice Address - Zip Code:38237-3394
Practice Address - Country:US
Practice Address - Phone:731-587-9511
Practice Address - Fax:877-309-6416
Is Sole Proprietor?:No
Enumeration Date:2005-07-18
Last Update Date:2021-05-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TNMD5113207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
712671OtherWELLCARE
TN3005840OtherBLUE CROSS BLUE SHIELD
TN3005840OtherBCBS
TN3144167Medicaid
4482791OtherAETNA
080020820Medicare ID - Type UnspecifiedRAILROAD MEDICARE
TN116896OtherUNISON HEALTH PLANS