Provider Demographics
NPI:1598765729
Name:SHAVER, JOHN K (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:K
Last Name:SHAVER
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:26732 CROWN VALLEY PKWY
Mailing Address - Street 2:SUITE 351
Mailing Address - City:MISSION VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92691-6306
Mailing Address - Country:US
Mailing Address - Phone:949-364-1007
Mailing Address - Fax:949-364-0317
Practice Address - Street 1:26732 CROWN VALLEY PKWY
Practice Address - Street 2:SUITE 351
Practice Address - City:MISSION VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92691-6306
Practice Address - Country:US
Practice Address - Phone:949-364-1007
Practice Address - Fax:949-364-0317
Is Sole Proprietor?:No
Enumeration Date:2005-07-29
Last Update Date:2016-02-23
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Provider Licenses
StateLicense IDTaxonomies
CAG67999208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWG67999AOtherPIN
CAF58770Medicare UPIN