Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VX0000X | Obstetrician | G64767 | CA |
NPI | 1205885662 |
---|---|
Provider Name | Dr. Dorothy A Shoup |
First Address | Redwood City, CA 94062-2843 |
Second Address | Redwood City, CA 94062-2843 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/05/2006 |
Last Update Date | 18/07/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
E73349 | (02) | CA |