Individual
DR. SHANE JOSEPH LARUE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
100 MEDICAL DR, HANNIBAL, MO 63401-6877
(573) 231-3167
(573) 221-1659
Mailing address
100 MEDICAL DR, HANNIBAL, MO 63401-6877
(573) 221-5250
(573) 221-1659
Taxonomy
Speciality
Code
Description
License number
State
207RA0001X
Advanced Heart Failure and Transplant Cardiology Physician
Primary
2009013305
MO
207RC0000X
Cardiovascular Disease Physician
2009013305
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1811955180
—
MO
05
—
ENROLLED
—
IL
Enumeration date
05/03/2006
Last updated
03/03/2021
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