Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RR0500X | Rheumatology | 98-01767 | NC |
NPI | 1043394901 |
---|---|
Provider Name | Joseph Charles Shanahan |
First Address | Durham, NC 27713-5271 |
Second Address | Durham, NC 27713-5271 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/10/2006 |
Last Update Date | 01/11/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
890138J | (05) | NC |
H35750 | (02) | NC |