Provider Demographics
NPI:1285626762
Name:SHIM, JOHN H (MD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:H
Last Name:SHIM
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 2220
Mailing Address - Street 2:
Mailing Address - City:OLDSMAR
Mailing Address - State:FL
Mailing Address - Zip Code:34677-7220
Mailing Address - Country:US
Mailing Address - Phone:813-814-9251
Mailing Address - Fax:813-814-9261
Practice Address - Street 1:309 STATE STREET EAST
Practice Address - Street 2:SUITE 201
Practice Address - City:OLDSMAR
Practice Address - State:FL
Practice Address - Zip Code:34677
Practice Address - Country:US
Practice Address - Phone:813-814-9251
Practice Address - Fax:813-814-9261
Is Sole Proprietor?:No
Enumeration Date:2005-08-19
Last Update Date:2021-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0063979207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL373583400Medicaid
FL23454CMedicare PIN
FL373583400Medicaid