Provider Demographics
NPI:1346300035
Name:SHALLENBERGER, FRANK ANTHONY (MD)
Entity type:Individual
Prefix:DR
First Name:FRANK
Middle Name:ANTHONY
Last Name:SHALLENBERGER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:FRANK
Other - Middle Name:ANTHONY
Other - Last Name:SHALLENBERGER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:1231 COUNTY CLUB DR.
Mailing Address - Street 2:
Mailing Address - City:CARSON CITY
Mailing Address - State:NV
Mailing Address - Zip Code:89703
Mailing Address - Country:US
Mailing Address - Phone:775-884-3990
Mailing Address - Fax:775-884-3990
Practice Address - Street 1:1231 COUNTRY CLUB DR
Practice Address - Street 2:
Practice Address - City:CARSON CITY
Practice Address - State:NV
Practice Address - Zip Code:89703
Practice Address - Country:US
Practice Address - Phone:775-884-3990
Practice Address - Fax:775-884-2202
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-11
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV4951207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVA43291Medicare UPIN