Provider Demographics
NPI:1255393906
Name:SHANKS, JAMES C (MD)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:C
Last Name:SHANKS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:1575 BEAM AVE
Mailing Address - Street 2:HEALTHEAST CANCER CARE
Mailing Address - City:MAPLEWOOD
Mailing Address - State:MN
Mailing Address - Zip Code:55109-1126
Mailing Address - Country:US
Mailing Address - Phone:651-232-7970
Mailing Address - Fax:651-232-7804
Practice Address - Street 1:1575 BEAM AVE
Practice Address - Street 2:HEALTHEAST CANCER CARE
Practice Address - City:MAPLEWOOD
Practice Address - State:MN
Practice Address - Zip Code:55109-1126
Practice Address - Country:US
Practice Address - Phone:651-232-7970
Practice Address - Fax:651-232-7804
Is Sole Proprietor?:No
Enumeration Date:2006-04-06
Last Update Date:2022-07-11
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MN48214207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNI34167Medicare UPIN