1376717025 NPI number — J. ANTHONY SHAHEEN MD INC

Table of content: (NPI 1376717025)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1376717025 NPI number — J. ANTHONY SHAHEEN MD INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
J. ANTHONY SHAHEEN MD INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
MONTEREY UROLOGY CENTER
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1376717025
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/26/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
910 MAJOR SHERMAN LN
Provider Second Line Business Mailing Address:
SUITE 205
Provider Business Mailing Address City Name:
MONTEREY
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
93940-4642
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
831-373-3600
Provider Business Mailing Address Fax Number:
831-373-0686

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
910 MAJOR SHERMAN LN
Provider Second Line Business Practice Location Address:
STE 205
Provider Business Practice Location Address City Name:
MONTEREY
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93940-4642
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
831-373-3600
Provider Business Practice Location Address Fax Number:
831-373-0686
Provider Enumeration Date:
04/14/2008

Additional Information

Authorized Official

Authorized Official Last Name:
SHAHEEN
Authorized Official First Name:
JOHN
Authorized Official Middle Name:
ANTHONY
Authorized Official Title or Position:
OWNER/OFFICER
Authorized Official Telephone Number:
831-917-1785

Provider Taxonomy Codes

  • Taxonomy code: 2085R0203X , with the licence number:  G77558 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208800000X , with the licence number: G783340 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: G783340 . This is a "PTAN" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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