# SHANE CARLSON DANGERFIELD

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** Yes

## Provider details

- **NPI number:** 1457685919
- **Gender:** Man
- **Credential:** M.D.

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208000000X | Pediatrics Physician | 9003692-1205 | UT | — |
| 2081P0010X | Pediatric Rehabilitation Medicine Physician | 4301094767 | MI | — |
| 2081P0010X | Pediatric Rehabilitation Medicine Physician | 9003692-1205 | UT | Yes |

## Other

- **Enumeration date:** 09/30/2009
- **Last updated:** 12/03/2021