Provider Demographics
NPI:1376717025
Name:J. ANTHONY SHAHEEN MD INC
Entity Type:Organization
Organization Name:J. ANTHONY SHAHEEN MD INC
Other - Org Name:MONTEREY UROLOGY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:SHAHEEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:831-917-1785
Mailing Address - Street 1:910 MAJOR SHERMAN LN
Mailing Address - Street 2:SUITE 205
Mailing Address - City:MONTEREY
Mailing Address - State:CA
Mailing Address - Zip Code:93940-4642
Mailing Address - Country:US
Mailing Address - Phone:831-373-3600
Mailing Address - Fax:831-373-0686
Practice Address - Street 1:910 MAJOR SHERMAN LN
Practice Address - Street 2:STE 205
Practice Address - City:MONTEREY
Practice Address - State:CA
Practice Address - Zip Code:93940-4642
Practice Address - Country:US
Practice Address - Phone:831-373-3600
Practice Address - Fax:831-373-0686
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-14
Last Update Date:2017-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG775582085R0203X
CAG783340208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Multi-Specialty
No2085R0203XAllopathic & Osteopathic PhysiciansRadiologyTherapeutic RadiologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG783340OtherPTAN