Provider Demographics
NPI:1932246584
Name:SHANKLE, WILLIAM RODMAN (MS, MD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:RODMAN
Last Name:SHANKLE
Suffix:
Gender:M
Credentials:MS, MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3900 W COAST HWY STE 310
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92663-4093
Mailing Address - Country:US
Mailing Address - Phone:949-478-8858
Mailing Address - Fax:949-242-2465
Practice Address - Street 1:3900 W COAST HWY STE 310
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92663-4093
Practice Address - Country:US
Practice Address - Phone:949-478-8858
Practice Address - Fax:949-242-2465
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-31
Last Update Date:2023-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG556392084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAD88349Medicare UPIN
CAG55639AMedicare ID - Type Unspecified