Individual
SHANE B CARSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
1919 S GRAND BLVD, SPOKANE, WA 99203-2347
(509) 747-3081
(509) 227-7070
Mailing address
PO BOX 421, LIBERTY LAKE, WA 99019-0421
(509) 747-3081
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
OP00002101
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
8454654
—
WA
Enumeration date
07/03/2006
Last updated
05/03/2021
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