Provider Demographics
NPI:1013991116
Name:SHANAHAN, WILLIAM SM (MD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:SM
Last Name:SHANAHAN
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:P.O. BOX 511228
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90051-2997
Mailing Address - Country:US
Mailing Address - Phone:562-698-0811
Mailing Address - Fax:562-309-8200
Practice Address - Street 1:12401 EAST WASHINGTON BLVD.
Practice Address - Street 2:PRESBYTERIAN INTERCOMMUNITY HOSP-RADIOLOGY DEPARTMENT
Practice Address - City:WHITTIER
Practice Address - State:CA
Practice Address - Zip Code:90602-1006
Practice Address - Country:US
Practice Address - Phone:562-698-0811
Practice Address - Fax:562-309-8200
Is Sole Proprietor?:No
Enumeration Date:2005-12-01
Last Update Date:2012-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG416182085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00GH16180OtherMEDI CAL
CA1205815107Medicaid
CA00G756000OtherBS OF CALIFORNIA
A89734Medicare UPIN