Active NPI
Lawrence Wayne Shivertaker, MD
- Independent Medical Examiner Physician
- Orange Park, FL
National Provider Identifier
1194963454
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Independent Medical Examiner Physician
- License
- ME60157
- Practice address
- 2486 Shalimar LN
Orange Park, FL 32073-6123 - Phone
- (904) 269-5274
- NPI assigned
- Jan 25, 2009
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Independent Medical Examiner Physician | 202C00000X | ME60157 | FL | Primary |
Addresses
Primary practice location
2486 Shalimar LN
Orange Park, FL 32073-6123
Mailing address
2486 Shalimar LN
Orange Park, FL 32073-6123
Phone (904) 269-5274
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| ME60157 | FL | MD | Independent Medical Examiner Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1232841600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1232841600000",
"number": "1194963454",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2486 SHALIMAR LN",
"city": "ORANGE PARK",
"state": "FL",
"postal_code": "320736123",
"telephone_number": "904-269-5274"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2486 SHALIMAR LN",
"city": "ORANGE PARK",
"state": "FL",
"postal_code": "320736123",
"telephone_number": "904-269-5274"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SHIVERTAKER",
"first_name": "LAWRENCE",
"middle_name": "WAYNE",
"name_prefix": "Dr.",
"credential": "MD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2009-01-25",
"last_updated": "2009-01-25",
"status": "A"
},
"taxonomies": [
{
"code": "202C00000X",
"taxonomy_group": "",
"desc": "Independent Medical Examiner",
"state": "FL",
"license": "ME60157",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Orange Park, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 25, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.