Individual
MATTHEW D. SHANE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1760 NICHOLASVILLE RD, SUITE 202, LEXINGTON, KY 40503-1472
(859) 277-5711
(859) 967-1769
Mailing address
1760 NICHOLASVILLE RD, SUITE 202, LEXINGTON, KY 40503-1472
(859) 277-5711
(859) 967-1769
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
41174
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7100018900
—
KY
Enumeration date
06/04/2006
Last updated
08/06/2015
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