Individual
DR. VINCENT STEPHEN SHALLOW
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2095 LYNX WAY, SAN MARCOS, CA 92078-0905
(760) 304-0226
Mailing address
2095 LYNX WAY, SAN MARCOS, CA 92078-0905
(760) 304-0226
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
123271
NY
208800000X
Urology Physician
Primary
A31633
CA
208800000X
Urology Physician
MD-16910
HI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2157538
MEDI-CAL
CA
Enumeration date
07/24/2007
Last updated
08/19/2013
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