Individual
SHANE A ANDREW
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
4424 E FLAMINGO AVE, SUITE 110, NAMPA, ID 83687
(208) 288-4700
(208) 288-4720
Mailing address
3340 E GOLDSTONE WAY, MERIDIAN, ID 83642-1026
(208) 367-5170
(208) 367-5180
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
O-0443
ID
207X00000X
Orthopaedic Surgery Physician
O0443
ID
207X00000X
Orthopaedic Surgery Physician
OS9764
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
807749400
—
ID
01
—
P00413752
RAILROAD MEDICARE
—
Enumeration date
04/26/2006
Last updated
10/22/2014
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