Provider Demographics
NPI:1982095352
Name:SHURE, WILLIAM JASON (MD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:JASON
Last Name:SHURE
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 1:1047 S SOUTHLAKE DR
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33019-1948
Mailing Address - Country:US
Mailing Address - Phone:954-980-1060
Mailing Address - Fax:954-927-2292
Practice Address - Street 1:1047 S SOUTHLAKE DR
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33019-1948
Practice Address - Country:US
Practice Address - Phone:954-980-1060
Practice Address - Fax:954-927-2292
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-06
Last Update Date:2015-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 0037427207V00000X
NY140158-1207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL066138400Medicaid
FL066138400Medicaid