Provider Demographics
NPI:1811979917
Name:GREER, SHANNON SCOTT (DO)
Entity type:Individual
Prefix:DR
First Name:SHANNON
Middle Name:SCOTT
Last Name:GREER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12631 WORLD PLAZA LN
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33907-3990
Mailing Address - Country:US
Mailing Address - Phone:239-267-3777
Mailing Address - Fax:866-835-7903
Practice Address - Street 1:12631 WORLD PLAZA LN
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33907-3990
Practice Address - Country:US
Practice Address - Phone:239-267-3777
Practice Address - Fax:866-835-7903
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-16
Last Update Date:2023-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS9512207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL298229OtherAVMED
FL272977600Medicaid
FL000013683GOtherHUMANA
FL03487OtherBC/BS OF FLORIDA
FL000013683GOtherHUMANA
FL03487YMedicare ID - Type Unspecified