Individual
JONATHAN SHADER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
297 LAKE HAVASU AVE S STE 204, LAKE HAVASU CITY, AZ 86403-6526
(928) 490-2121
Mailing address
297 LAKE HAVASU AVE S STE 204, LAKE HAVASU CITY, AZ 86403-6526
(928) 490-2121
(706) 721-1158
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
010033
AZ
207W00000X
Ophthalmology Physician
10760
GA
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
04/12/2016
Last updated
09/18/2024
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