Provider Demographics
NPI:1730459041
Name:SHANTZ, JESSE ALAN (MD, MBA)
Entity Type:Individual
Prefix:DR
First Name:JESSE
Middle Name:ALAN
Last Name:SHANTZ
Suffix:
Gender:M
Credentials:MD, MBA
Other - Prefix:DR
Other - First Name:JESSE
Other - Middle Name:ALAN
Other - Last Name:SLADE SHANTZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD, MBA
Mailing Address - Street 1:580 MISSISSIPPI ST
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94107-2935
Mailing Address - Country:US
Mailing Address - Phone:415-852-2127
Mailing Address - Fax:415-647-3733
Practice Address - Street 1:2550 23RD ST
Practice Address - Street 2:BUILDING 9, 2ND FLOOR
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94110-3504
Practice Address - Country:US
Practice Address - Phone:415-206-8812
Practice Address - Fax:415-647-3733
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-03
Last Update Date:2012-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA119543207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery