Provider Demographics
NPI:1467707406
Name:PLOWMAN, SHAWN PHILIP (PA-C MMS)
Entity Type:Individual
Prefix:
First Name:SHAWN
Middle Name:PHILIP
Last Name:PLOWMAN
Suffix:
Gender:M
Credentials:PA-C MMS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 CORPORATE DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:LADERA RANCH
Mailing Address - State:CA
Mailing Address - Zip Code:92694-1152
Mailing Address - Country:US
Mailing Address - Phone:949-364-9112
Mailing Address - Fax:949-364-9016
Practice Address - Street 1:800 CORPORATE DR
Practice Address - Street 2:SUITE 100
Practice Address - City:LADERA RANCH
Practice Address - State:CA
Practice Address - Zip Code:92694-1152
Practice Address - Country:US
Practice Address - Phone:949-364-9112
Practice Address - Fax:949-364-9016
Is Sole Proprietor?:No
Enumeration Date:2012-07-16
Last Update Date:2017-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA22377363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACB210363Medicare PIN