Provider Demographics
NPI:1740371509
Name:SHIRLEY, FRANK A (MD)
Entity type:Individual
Prefix:DR
First Name:FRANK
Middle Name:A
Last Name:SHIRLEY
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:PO BOX 4046
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65808-4046
Mailing Address - Country:US
Mailing Address - Phone:417-236-2440
Mailing Address - Fax:417-354-1458
Practice Address - Street 1:801 N. LINCOLN AVE
Practice Address - Street 2:STE E
Practice Address - City:MONETT
Practice Address - State:MO
Practice Address - Zip Code:65708-1641
Practice Address - Country:US
Practice Address - Phone:417-236-2440
Practice Address - Fax:417-354-1458
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2013-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR8819208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
115990OtherBLUE CROSS OF MO
MO209687441Medicaid
948495115Medicare PIN
MO209687441Medicaid
D95644Medicare UPIN
020052153Medicare PIN
P00371907Medicare PIN