Provider Demographics
NPI:1679530844
Name:SHATTIL, SANFORD J (MD)
Entity type:Individual
Prefix:DR
First Name:SANFORD
Middle Name:J
Last Name:SHATTIL
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:9500 GILMAN DR
Mailing Address - Street 2:UCSD, LEICHTAG BIOMEDICAL RESEARCH BLDG, ROOM 180
Mailing Address - City:LA JOLLA
Mailing Address - State:CA
Mailing Address - Zip Code:92093-5004
Mailing Address - Country:US
Mailing Address - Phone:858-822-6425
Mailing Address - Fax:858-822-6444
Practice Address - Street 1:200 W ARBOR DR
Practice Address - Street 2:UCSD MEDICAL CENTER
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92103-9000
Practice Address - Country:US
Practice Address - Phone:888-309-8273
Practice Address - Fax:619-543-3183
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG22082207R00000X, 207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Not Answered207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G220820Medicaid
CA00G220820Medicaid
CAWG22082KMedicare ID - Type Unspecified