Provider Demographics
NPI:1760411359
Name:SHANER, THOMAS P (MD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:P
Last Name:SHANER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:12639 OLD TESSON RD
Mailing Address - Street 2:SUITE 115
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63128-2786
Mailing Address - Country:US
Mailing Address - Phone:314-849-0311
Mailing Address - Fax:314-849-4423
Practice Address - Street 1:621 S NEW BALLAS RD
Practice Address - Street 2:SUITE 695A
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63141-8232
Practice Address - Country:US
Practice Address - Phone:314-872-7400
Practice Address - Fax:314-872-9126
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2007-07-08
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Provider Licenses
StateLicense IDTaxonomies
MO34683207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO112118OtherBLUE CROSS BLUE SHIELD
MO122339OtherHEALTHLINK
MO4272667OtherAETNA
A13252Medicare UPIN