Provider Demographics
NPI:1396861951
Name:SHANGLE, CARL EDWIN (MD)
Entity Type:Individual
Prefix:DR
First Name:CARL
Middle Name:EDWIN
Last Name:SHANGLE
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1201 W LA VETA AVE
Mailing Address - Street 2:CHOC CHILDREN'S SPECIALISTS
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92868-4203
Mailing Address - Country:US
Mailing Address - Phone:714-509-3096
Mailing Address - Fax:714-509-3096
Practice Address - Street 1:1201 W LA VETA AVE
Practice Address - Street 2:CHOC CHILDREN'S SPECIALISTS
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92868-4203
Practice Address - Country:US
Practice Address - Phone:714-509-3096
Practice Address - Fax:714-509-3096
Is Sole Proprietor?:No
Enumeration Date:2007-03-22
Last Update Date:2021-11-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA1044992080N0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA104499OtherMEDICAL LICENSE