Individual
SHANE CARLSON DANGERFIELD
Active
Individual
SHANE CARLSON DANGERFIELD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
9003692-1205
UT
2081P0010X
Pediatric Rehabilitation Medicine Physician
4301094767
MI
2081P0010X
Pediatric Rehabilitation Medicine Physician
Primary
9003692-1205
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1457685919
—
UT
Enumeration date
09/30/2009
Last updated
12/03/2021
Update your record
If you believe information in your NPPES record is inaccurate, or if you wish to update or deactivate your NPI, you can do so directly with CMS at https://nppes.cms.hhs.gov.
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