Individual
RICHARD B SHORE II
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
2401 W UNIVERSITY AVE, MUNCIE, IN 47303-3428
(765) 751-1720
(765) 741-2961
Mailing address
250 N SHADELAND AVE, INDIANAPOLIS, IN 46219-4959
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
10002567A
IN
363AM0700X
Medical Physician Assistant
Primary
10002567A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000001209830
ANTHEM PTAN
IN
05
—
300018762
—
IN
01
—
P02264852
RAILROAD PTAN
IN
Enumeration date
09/11/2018
Last updated
02/16/2025
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