Individual
DR. VINCENT STEPHEN SHALLOW
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
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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