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General NPI Number Information
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NPI Number | 1083917918
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Entity Type | Organization
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Legal Business Name | JAMES W SHANER M D A MEDICAL CORPORATION
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Dates
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Enumeration Date | 12/15/2010
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Last Update Date | 03/21/2011
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Provider Practice Location Address
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Address Line | 173 S CIVIC DR STE 4
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City | PALM SPRINGS
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State | CA
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Zip | 92262-7215
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Country | US
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Telephone | 760-864-6688
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Fax | 760-864-6686
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Provider Business Mailing Address
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Address Line | 173 S CIVIC DR SUITE 4
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City | PALM SPRINGS
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State | CA
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Zip | 92262-7215
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Country | US
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Telephone | 760-864-6688
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Fax | 760-864-6686
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Authorized Official
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Title or Position | DOCTOR
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Name | JAMES SHANER
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Credential | M D
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Telephone | 760-864-6688
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | G25057
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License Number State | CA
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