Provider Demographics
NPI:1942217385
Name:SHUTER, ISRAEL DAVID (MD)
Entity Type:Individual
Prefix:DR
First Name:ISRAEL
Middle Name:DAVID
Last Name:SHUTER
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 1:2151 S ALTERNATE A1A STE 1000
Mailing Address - Street 2:
Mailing Address - City:JUPITER
Mailing Address - State:FL
Mailing Address - Zip Code:33477-4098
Mailing Address - Country:US
Mailing Address - Phone:561-743-0244
Mailing Address - Fax:561-743-4250
Practice Address - Street 1:2151 S ALTERNATE A1A STE 1000
Practice Address - Street 2:
Practice Address - City:JUPITER
Practice Address - State:FL
Practice Address - Zip Code:33477-4098
Practice Address - Country:US
Practice Address - Phone:561-743-0244
Practice Address - Fax:561-743-4250
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-01
Last Update Date:2019-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME-0056949208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLE16879Medicare UPIN
FL10362Medicare ID - Type Unspecified