Provider Demographics
NPI:1275560484
Name:SHIRLEY, DAVID FREDERICK (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:FREDERICK
Last Name:SHIRLEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:3031 STANFORD RANCH RD
Mailing Address - Street 2:SUITE 2, #220
Mailing Address - City:ROCKLIN
Mailing Address - State:CA
Mailing Address - Zip Code:95765-5554
Mailing Address - Country:US
Mailing Address - Phone:916-677-7962
Mailing Address - Fax:916-435-2964
Practice Address - Street 1:3031 STANFORD RANCH RD
Practice Address - Street 2:SUITE 2, #220
Practice Address - City:ROCKLIN
Practice Address - State:CA
Practice Address - Zip Code:95765-5554
Practice Address - Country:US
Practice Address - Phone:916-677-7962
Practice Address - Fax:916-435-2964
Is Sole Proprietor?:No
Enumeration Date:2006-06-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG66004207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
E29236Medicare UPIN
ZZZ24568ZMedicare ID - Type Unspecified