Provider Demographics
NPI:1114096898
Name:SHANKS, DAVID E
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:E
Last Name:SHANKS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3717 LATROBE DR STE 750
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28211-4826
Mailing Address - Country:US
Mailing Address - Phone:704-364-6676
Mailing Address - Fax:704-364-1358
Practice Address - Street 1:3717 LATROBE DR STE 750
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28211-4826
Practice Address - Country:US
Practice Address - Phone:704-364-6676
Practice Address - Fax:704-364-1358
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-07
Last Update Date:2009-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC20440207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC75428OtherBLUE CROSS
NC8975428Medicaid
NC561254125OtherCIGNA HEALTHCARE
NC406291010OtherPALMETTO GBA RR MEDICARE
NC561254125OtherUNITED HEALTHCARE
NC30596OtherMEDCOST
NC30596OtherMEDCOST
NC406291010OtherPALMETTO GBA RR MEDICARE