Provider Demographics
NPI:1164497491
Name:LIMON, SHAUN JASON (DPM)
Entity type:Individual
Prefix:DR
First Name:SHAUN
Middle Name:JASON
Last Name:LIMON
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:11065 GATEWOOD DR STE C-102
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD RANCH
Mailing Address - State:FL
Mailing Address - Zip Code:34211-4944
Mailing Address - Country:US
Mailing Address - Phone:941-756-6906
Mailing Address - Fax:941-751-0976
Practice Address - Street 1:11065 GATEWOOD DR # C-102
Practice Address - Street 2:
Practice Address - City:LAKEWOOD RANCH
Practice Address - State:FL
Practice Address - Zip Code:34211-4944
Practice Address - Country:US
Practice Address - Phone:941-782-8639
Practice Address - Fax:941-751-0976
Is Sole Proprietor?:No
Enumeration Date:2006-02-21
Last Update Date:2023-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO2722213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL390424500Medicaid
FL65569Medicare PIN
FL3922430001Medicare NSC
FL390424500Medicaid