MEDICARE: L. RICHARD SHEARER, M.D., INC.

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	207Y00000X	Otolaryngology Physician	G37221	CA

General Provider Information

NPI Number	:	1518094911
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	L. RICHARD SHEARER, M.D., INC.

Provider Business Mailing Address
First Line	:	701 PINE ST
Second Line	:
City	:	MOUNT SHASTA
State	:	CA
Zip	:	96067-2133
Country	:	US
Telephone Number	:	530-926-6222
Fax Number	:	530-926-0444

Provider Business Practice Location Address
First Line	:	701 PINE ST
Second Line	:
City	:	MOUNT SHASTA
State	:	CA
Zip	:	96067-2133
Country	:	US
Telephone Number	:	530-926-6222
Fax Number	:	530-926-0444

Authorized Official
Title or Position	:	PRESIDENT
Name	:	LAWRENCE RICHARD SHEARER
Credential	:	M.D.
Telephone Number	:	530-926-6222

Provider Enumeration Date	:	02/27/2007
Last Update Date	:	09/13/2007

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