MEDICARE: DR. ALLAN SHANBERG MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208800000X	Urology Physician	G10600	CA

General Provider Information

NPI Number	:	1508979428
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ALLAN SHANBERG MD

Provider Business Mailing Address
First Line	:	1509 EMERALD BAY
Second Line	:
City	:	LAGUNA BEACH
State	:	CA
Zip	:	92651-1235
Country	:	US
Telephone Number	:	714-456-8900
Fax Number	:

Provider Business Practice Location Address
First Line	:	1509 EMERALD BAY
Second Line	:
City	:	LAGUNA BEACH
State	:	CA
Zip	:	92651-1235
Country	:	US
Telephone Number	:	714-456-8900
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/16/2006
Last Update Date	:	07/08/2007

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