Provider Demographics
NPI:1396378980
Name:DAVID F SHIRLEY M D P C
Entity Type:Organization
Organization Name:DAVID F SHIRLEY M D P C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:F
Authorized Official - Last Name:SHIRLEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:916-677-9834
Mailing Address - Street 1:3031 STANFORD RANCH RD STE 2
Mailing Address - Street 2:
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 1:4001 IMPALA CIRCLE
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95678
Practice Address - Country:US
Practice Address - Phone:916-677-7962
Practice Address - Fax:916-435-2964
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-21
Last Update Date:2020-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric MedicineGroup - Single Specialty