Provider Demographics
NPI:1144406711
Name:SHEARER, L. RICHARD (MD)
Entity Type:Individual
Prefix:
First Name:L.
Middle Name:RICHARD
Last Name:SHEARER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:701 PINE ST
Mailing Address - Street 2:
Mailing Address - City:MOUNT SHASTA
Mailing Address - State:CA
Mailing Address - Zip Code:96067-2133
Mailing Address - Country:US
Mailing Address - Phone:530-926-6222
Mailing Address - Fax:530-926-0444
Practice Address - Street 1:701 PINE ST
Practice Address - Street 2:
Practice Address - City:MOUNT SHASTA
Practice Address - State:CA
Practice Address - Zip Code:96067-2133
Practice Address - Country:US
Practice Address - Phone:530-926-6222
Practice Address - Fax:530-926-0444
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-14
Last Update Date:2012-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG37221207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA46998Medicare UPIN
CA00G372210Medicare PIN