Organization
DAVID E. SHANKS, PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DAVID E SHANKS PA (CORPORATION)
(704) 364-6676
Entity
Organization
Contact information
Practice address
3717 LATROBE DR STE 750, CHARLOTTE, NC 28211-4826
(704) 364-6676
(704) 364-1358
Mailing address
3717 LATROBE DR STE 750, CHARLOTTE, NC 28211-4826
(704) 364-6676
(704) 364-1358
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
30596
MEDCOST
NC
01
—
406291010
PALMETTO GBA RR MEDICARE
NC
01
—
75428
BLUE CROSS
NC
05
—
8975428
—
NC
Enumeration date
11/07/2006
Last updated
08/25/2009
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