Provider Demographics
NPI:1194070268
Name:DAVID SHUTER MD PA
Entity type:Organization
Organization Name:DAVID SHUTER MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ISRAEL
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:SHUTER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:561-743-0244
Mailing Address - Street 1:730 W INDIANTOWN RD
Mailing Address - Street 2:
Mailing Address - City:JUPITER
Mailing Address - State:FL
Mailing Address - Zip Code:33458-7507
Mailing Address - Country:US
Mailing Address - Phone:561-743-0244
Mailing Address - Fax:561-743-4250
Practice Address - Street 1:730 W INDIANTOWN RD
Practice Address - Street 2:
Practice Address - City:JUPITER
Practice Address - State:FL
Practice Address - Zip Code:33458-7507
Practice Address - Country:US
Practice Address - Phone:561-743-0244
Practice Address - Fax:561-743-4250
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-16
Last Update Date:2012-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME-0056949208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLE16879Medicare UPIN