MEDICARE: FRED F SHAHAN 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	207N00000X	Dermatology Physician	G83901	CA

General Provider Information

NPI Number	:	1811913221
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	FRED F SHAHAN MD

Provider Business Mailing Address
First Line	:	6367 ALVARADO CT
Second Line	:	SUITE 107
City	:	SAN DIEGO
State	:	CA
Zip	:	92120-4904
Country	:	US
Telephone Number	:	619-287-1882
Fax Number	:	619-287-4121

Provider Business Practice Location Address
First Line	:	6367 ALVARADO CT
Second Line	:	SUITE 107
City	:	SAN DIEGO
State	:	CA
Zip	:	92120-4904
Country	:	US
Telephone Number	:	619-287-1882
Fax Number	:	619-287-4121

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

Provider Enumeration Date	:	07/15/2006
Last Update Date	:	12/27/2010

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Directions to “ FRED F SHAHAN MD” Practice Location

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