Provider Demographics
NPI:1598879595
Name:SHEN, ALFRED C (MD)
Entity Type:Individual
Prefix:DR
First Name:ALFRED
Middle Name:C
Last Name:SHEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:72780 COUNTRY CLUB DR
Mailing Address - Street 2:STE A104
Mailing Address - City:RANCHO MIRAGE
Mailing Address - State:CA
Mailing Address - Zip Code:92270-4150
Mailing Address - Country:US
Mailing Address - Phone:760-837-8020
Mailing Address - Fax:760-834-3780
Practice Address - Street 1:72780 COUNTRY CLUB DR STE A104
Practice Address - Street 2:
Practice Address - City:RANCHO MIRAGE
Practice Address - State:CA
Practice Address - Zip Code:92270-4150
Practice Address - Country:US
Practice Address - Phone:760-837-8020
Practice Address - Fax:760-834-3780
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-18
Last Update Date:2016-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA52041207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG70486Medicare UPIN
CAA52041Medicare ID - Type Unspecified
CAA52041Medicare ID - Type Unspecified