MEDICARE: PAULA B. SHORE D.O.

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	207Q00000X	Family Medicine Physician	20A7172	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	20A7172	OTHER	CA	LICENSE NUMBER

General Provider Information

NPI Number	:	1366635658
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PAULA B. SHORE D.O.

Provider Business Mailing Address
First Line	:	4645 PARK DR
Second Line	:	APT C
City	:	CARLSBAD
State	:	CA
Zip	:	92008-4248
Country	:	US
Telephone Number	:	760-476-2953
Fax Number	:

Provider Business Practice Location Address
First Line	:	6260 EL CAMINO REAL
Second Line	:
City	:	CARLSBAD
State	:	CA
Zip	:	92009-1609
Country	:	US
Telephone Number	:	760-476-2953
Fax Number	:

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

Provider Enumeration Date	:	08/21/2007
Last Update Date	:	03/31/2011

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