Provider Demographics
NPI:1477663821
Name:SHANER, JAMES WESLEY (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:WESLEY
Last Name:SHANER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:173 S CIVIC DR STE 4
Mailing Address - Street 2:
Mailing Address - City:PALM SPRINGS
Mailing Address - State:CA
Mailing Address - Zip Code:92262-7215
Mailing Address - Country:US
Mailing Address - Phone:760-864-6688
Mailing Address - Fax:760-864-6686
Practice Address - Street 1:173 S CIVIC DR STE 4
Practice Address - Street 2:
Practice Address - City:PALM SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:92262-7215
Practice Address - Country:US
Practice Address - Phone:760-864-6688
Practice Address - Fax:760-864-6686
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2008-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG25057208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA42502Medicare UPIN
CA00G25057Medicare PIN