MEDICARE: MATTHEW D SHORES 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	207Q00000X	Family Medicine Physician	36166	AZ

General Provider Information

NPI Number	:	1861513889
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MATTHEW D SHORES MD

Provider Business Mailing Address
First Line	:	5747 N 12TH PL
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85014-2328
Country	:	US
Telephone Number	:	480-414-9868
Fax Number	:

Provider Business Practice Location Address
First Line	:	5747 N 12TH PL
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85014-2328
Country	:	US
Telephone Number	:	480-414-9868
Fax Number	:

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

Provider Enumeration Date	:	04/03/2007
Last Update Date	:	07/27/2021

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