Individual
IVAN COURTNEY SHORTER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
169 MARTIN AVE, EPHRATA, PA 17522-1734
(717) 733-0311
(717) 721-5861
Mailing address
3421 CONCORD RD, YORK, PA 17402-9001
(717) 733-0311
(717) 721-5861
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
OS013175
PA
207Q00000X
Family Medicine Physician
OS013175
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
102334947
—
PA
01
—
1584982
GATEWAY
PA
01
—
2119476
HIGHMARK BLUE SHIELD
PA
Enumeration date
08/01/2006
Last updated
03/20/2025
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