Provider Demographics
NPI:1235324666
Name:MCSHANE, ELIZABETH J (MD)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:J
Last Name:MCSHANE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12291 E. WASHINGTON BLVD,
Mailing Address - Street 2:SUITE 203
Mailing Address - City:WHITTIER
Mailing Address - State:CA
Mailing Address - Zip Code:90606-2549
Mailing Address - Country:US
Mailing Address - Phone:562-698-2200
Mailing Address - Fax:562-698-5282
Practice Address - Street 1:12291 E. WASHINGTON BLVD,
Practice Address - Street 2:SUITE 203
Practice Address - City:WHITTIER
Practice Address - State:CA
Practice Address - Zip Code:90606-2549
Practice Address - Country:US
Practice Address - Phone:562-698-2200
Practice Address - Fax:562-698-5282
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-10
Last Update Date:2007-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG73098207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAF36201Medicare UPIN
CAG73098Medicare PIN