Individual
SHANE JOSEPH EWALT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PHYSICIAN ASSISTANT
Contact information
Practice address
525 S CHANDLER VILLAGE DR, CHANDLER, AZ 85226-5069
(480) 750-0303
(480) 786-5202
Mailing address
PO BOX 80217, PHOENIX, AZ 85060-0217
(602) 385-2115
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
6865
AZ
363AS0400X
Surgical Physician Assistant
6865
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
326698
—
AZ
Enumeration date
09/07/2017
Last updated
07/29/2022
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