Jacob Moss Shaner, MD

Primary specialty

Anatomic Pathology & Clinical Pathology PhysicianTaxonomy code 207ZP0102X

License

R81861 Issued in AZ

Practice address

PO Box 245043
Tucson, AZ 85724-5043

Phone

(520) 626-5669

NPI assigned

May 28, 2025

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Medicine

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1748390400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1748390400000",
    "number": "1053104208",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7185 S PASEO MONTE DE ORO",
            "city": "TUCSON",
            "state": "AZ",
            "postal_code": "857568368",
            "telephone_number": "208-473-1097"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "PO BOX 245043",
            "city": "TUCSON",
            "state": "AZ",
            "postal_code": "857245043",
            "telephone_number": "520-626-5669"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHANER",
        "first_name": "JACOB",
        "middle_name": "MOSS",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2025-05-28",
        "last_updated": "2025-05-28",
        "certification_date": "2025-05-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207ZP0102X",
            "taxonomy_group": "",
            "desc": "Pathology, Anatomic Pathology & Clinical Pathology",
            "state": "AZ",
            "license": "R81861",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Shamballa Enterprises, LLC
• Yanina V, Shames, PNP
• Saqib Jawed Shami, MD
• Nasheed M. Shams Schimmels, MD
• Ashwinikumar Veerendra Shandilya, MBBS
• Samuel Kenneth Shaner
• Carrie Shanks
• Lauryn Christine Shannon
• Moira Shannon, MD
• Rashad Shannon

• Anatomic Pathology & Clinical Pathology Physician in Tucson, AZ
• Providers in Tucson, AZ by specialty
• Anatomic Pathology & Clinical Pathology Physician in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 28, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.