Individual
DR. SHANE NATHANIEL MCCAULEY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
6051 W EMERALD ST, BOISE, ID 83704
(208) 302-7600
(208) 302-7605
Mailing address
3340 E GOLDSTONE DR., MERIDIAN, ID 83642
(208) 302-7600
(208) 302-7605
Taxonomy
Speciality
Code
Description
License number
State
171000000X
Military Health Care Provider
01059435A
IN
207Q00000X
Family Medicine Physician
01059435A
IN
207Q00000X
Family Medicine Physician
M-14730
ID
2083A0100X
Aerospace Medicine Physician
01059435A
IN
2083X0100X
Occupational Medicine Physician
Primary
M-14730
ID
Other
Enumeration date
10/20/2005
Last updated
11/05/2019
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