Provider Demographics
NPI:1972581288
Name:ICE, SHIRLEY A (MD)
Entity type:Individual
Prefix:MS
First Name:SHIRLEY
Middle Name:A
Last Name:ICE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:10762 SE US HIGHWAY 441
Mailing Address - Street 2:
Mailing Address - City:BELLEVIEW
Mailing Address - State:FL
Mailing Address - Zip Code:34420-3805
Mailing Address - Country:US
Mailing Address - Phone:352-347-5225
Mailing Address - Fax:352-347-1073
Practice Address - Street 1:10762 SE US HIGHWAY 441
Practice Address - Street 2:
Practice Address - City:BELLEVIEW
Practice Address - State:FL
Practice Address - Zip Code:34420-3805
Practice Address - Country:US
Practice Address - Phone:352-347-5225
Practice Address - Fax:352-347-1073
Is Sole Proprietor?:No
Enumeration Date:2006-01-06
Last Update Date:2014-07-03
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLME71113207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL253203400Medicaid
G53771Medicare UPIN
FL253203400Medicaid