Provider Demographics
NPI:1366594780
Name:EASTERN SHORE MEDICAL SPECIALISTS, LLC
Entity type:Organization
Organization Name:EASTERN SHORE MEDICAL SPECIALISTS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:E
Authorized Official - Last Name:GOETTER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:251-928-8804
Mailing Address - Street 1:3 MEDICAL PARK
Mailing Address - Street 2:
Mailing Address - City:FAIRHOPE
Mailing Address - State:AL
Mailing Address - Zip Code:36532-1873
Mailing Address - Country:US
Mailing Address - Phone:251-928-8804
Mailing Address - Fax:251-990-9379
Practice Address - Street 1:3 MEDICAL PARK
Practice Address - Street 2:
Practice Address - City:FAIRHOPE
Practice Address - State:AL
Practice Address - Zip Code:36532-1873
Practice Address - Country:US
Practice Address - Phone:251-928-8804
Practice Address - Fax:251-990-9379
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-17
Last Update Date:2007-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL5959174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
E462Medicare ID - Type Unspecified