Individual
MR. WILLIAM SHANE MCCLANAHAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
1409 KINGSLEY AVE STE 14A, ORANGE PARK, FL 32073-4541
(904) 213-3555
(904) 272-1222
Mailing address
1409 KINGSLEY AVE STE 14A, ORANGE PARK, FL 32073-4541
(904) 213-3555
(904) 272-1222
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
PA2114
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
291267800
—
FL
Enumeration date
10/31/2005
Last updated
10/17/2008
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