Provider Demographics
NPI:1659634269
Name:SHANER, JOHN ADAM (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:ADAM
Last Name:SHANER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2213 CHERRY ST
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43608-2603
Mailing Address - Country:US
Mailing Address - Phone:419-251-4724
Mailing Address - Fax:419-251-2698
Practice Address - Street 1:4750 HEMPSTEAD STATION DR
Practice Address - Street 2:
Practice Address - City:KETTERING
Practice Address - State:OH
Practice Address - Zip Code:45429-5164
Practice Address - Country:US
Practice Address - Phone:800-875-0136
Practice Address - Fax:937-619-4150
Is Sole Proprietor?:No
Enumeration Date:2012-06-19
Last Update Date:2014-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
OH35-122761207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program