Provider Demographics
NPI:1053347815
Name:SHORE, LAWRENCE GLEASON (MD)
Entity type:Individual
Prefix:DR
First Name:LAWRENCE
Middle Name:GLEASON
Last Name:SHORE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1700 CALIFORNIA ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94109-4586
Mailing Address - Country:US
Mailing Address - Phone:415-386-5388
Mailing Address - Fax:415-386-8406
Practice Address - Street 1:1700 CALIFORNIA ST
Practice Address - Street 2:SUITE 100
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94109-4586
Practice Address - Country:US
Practice Address - Phone:415-386-5388
Practice Address - Fax:415-386-8406
Is Sole Proprietor?:No
Enumeration Date:2006-06-24
Last Update Date:2019-10-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG40380207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G403801OtherPPIN
CAG40380OtherSTATE MEDICAL LICENSE
CAZZZ02349ZMedicare ID - Type UnspecifiedGROUP ID
CA00G403801OtherPPIN