Individual
JOHN STEPHEN SHANK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
350 FAIRVIEW HEIGHTS RD, SUMMERSVILLE, WV 26651
(304) 872-5090
(304) 872-0636
Mailing address
PO BOX 1029, SUMMERSVILLE, WV 26651-0139
(304) 872-5090
(304) 872-0636
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
11777
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0055930000
—
WV
01
—
550775750
TAX ID
—
Enumeration date
10/14/2005
Last updated
04/21/2022
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