Provider Demographics
NPI:1629330394
Name:MCSHANE, SCOTT JACOB (DO)
Entity Type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:JACOB
Last Name:MCSHANE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:105 W 8TH AVE STE 6010
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99204-2318
Mailing Address - Country:US
Mailing Address - Phone:509-838-5950
Mailing Address - Fax:602-839-2084
Practice Address - Street 1:105 W 8TH AVE STE 6010
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99204-2318
Practice Address - Country:US
Practice Address - Phone:509-838-5950
Practice Address - Fax:602-839-2084
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-08
Last Update Date:2023-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZR2118207R00000X
WAOP60908904207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology