Individual
SHANE JAMES MCGONEGLE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1055 N CURTIS RD, BOISE, ID 83706-1309
(208) 367-2161
(208) 367-2989
Mailing address
PO BOX 9649, BOISE, ID 83707-4649
(208) 472-8100
(208) 472-8172
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
M10653
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
808373900
—
ID
Enumeration date
03/26/2008
Last updated
02/18/2010
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