Provider Demographics
NPI:1902852239
Name:SHUTTER, JAMIE DAVID (MD)
Entity type:Individual
Prefix:DR
First Name:JAMIE
Middle Name:DAVID
Last Name:SHUTTER
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 25317
Mailing Address - Street 2:#207
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33622-5317
Mailing Address - Country:US
Mailing Address - Phone:813-286-0033
Mailing Address - Fax:813-282-1806
Practice Address - Street 1:6250 N DURANGO DR
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89149-3916
Practice Address - Country:US
Practice Address - Phone:702-342-9990
Practice Address - Fax:702-485-2372
Is Sole Proprietor?:No
Enumeration Date:2006-05-26
Last Update Date:2024-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0091999207ZP0102X
NC2011-00052207ZP0102X
DCMD036095207ZP0102X
TXR9435207ZP0102X
FLME 98596207ZP0102X
NV25728207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC162VJOtherBCBSNC
NC5916767Medicaid
FL278431900Medicaid
FL01299OtherBLUE CROSS BLUE SHIELD
FL278431900Medicaid
NC2077174Medicare PIN