Provider Demographics
NPI:1881766863
Name:MCSHANE, PATRICK ANDERSON (DPM)
Entity type:Individual
Prefix:DR
First Name:PATRICK
Middle Name:ANDERSON
Last Name:MCSHANE
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1834 S STEWART AVE
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65804-2519
Mailing Address - Country:US
Mailing Address - Phone:417-889-3338
Mailing Address - Fax:417-889-0953
Practice Address - Street 1:1834 S STEWART AVE
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65804-2519
Practice Address - Country:US
Practice Address - Phone:417-889-3338
Practice Address - Fax:417-889-0953
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-14
Last Update Date:2017-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO00632213EP1101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO360359707Medicaid
MO9932OtherBCBS PROVIDER #
MO500359708Medicaid
MO500359708Medicaid
MO360359707Medicaid
MO212334379Medicare ID - Type UnspecifiedMEDICARE INDIVIDUAL