Provider Demographics
NPI:1346254547
Name:SHONERD, JOHN PAUL (DO)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:PAUL
Last Name:SHONERD
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2900 DOCTORS PARK DR
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97504-8127
Mailing Address - Country:US
Mailing Address - Phone:541-282-2200
Mailing Address - Fax:541-282-2237
Practice Address - Street 1:3524 HEATHROW WAY
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97504-2770
Practice Address - Country:US
Practice Address - Phone:541-646-3505
Practice Address - Fax:541-646-3553
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2010-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORDO13134207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR269282Medicaid
ORE38904Medicare UPIN
OR269282Medicaid