| Shirley A Ice Md Pa | |
|
19204 E Pennsylvania Ave Dunnellon FL 34432-6111 | |
| (352) 465-2449 | |
| (352) 465-2451 |
| Full Name | Shirley A Ice Md Pa |
|---|---|
| Speciality | Family Medicine |
| Location | 19204 E Pennsylvania Ave, Dunnellon, Florida |
| Authorized Official Name and Position | Shirley A Ice (PRESIDENT) |
| Authorized Official Contact | 3524652449 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Shirley A Ice Md Pa 19204 E Pennsylvania Ave Dunnellon FL 34432-6111 Ph: (352) 465-2449 | Shirley A Ice Md Pa 19204 E Pennsylvania Ave Dunnellon FL 34432-6111 Ph: (352) 465-2449 |
| NPI Number | 1720249410 |
|---|---|
| Provider Enumeration Date | 06/24/2008 |
| Last Update Date | 11/02/2010 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1720249410 | NPI | - | NPPES |
| 2532203400 | Medicaid | FL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | ME0071113 (Florida) | Primary |
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