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Individual

DR. EDWARD GRANT SHORE

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
15243 VANOWEN ST STE 412, VAN NUYS, CA 91405-3662
(818) 783-4800
(818) 781-6644
Mailing address
4139 CAMINO DE LA CUMBRE, SHERMAN OAKS, CA 91423-4023
(818) 789-7032

Taxonomy

Speciality
Code
Description
License number
State
207QA0505X
Adult Medicine Physician
Primary
G7953
CA

Other

Enumeration date
11/11/2006
Last updated
07/08/2007
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