MEDICARE: DR. JOHN E. SHANER M.D.

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	207R00000X	Internal Medicine Physician	35048658-S	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1285624411
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOHN E. SHANER M.D.

Provider Business Mailing Address
First Line	:	1692 GLYNCO PARKWAY
Second Line	:
City	:	BRUNSWICK
State	:	GA
Zip	:	31525
Country	:	US
Telephone Number	:	912-265-4735
Fax Number	:	912-265-6100

Provider Business Practice Location Address
First Line	:	1692 GLYNCO PARKWAY
Second Line	:
City	:	BRUNSWICK
State	:	GA
Zip	:	31525
Country	:	US
Telephone Number	:	912-265-4735
Fax Number	:	912-265-6100

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

Provider Enumeration Date	:	10/27/2005
Last Update Date	:	12/31/2013

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