Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Y00000X | Otolaryngologist (ENT Doctor) | C025174 | CA |
NPI | 1043243058 |
---|---|
Provider Name | Dr. George L. Shoptaw |
First Address | Los Gatos, CA 95032-1442 |
Second Address | Los Gatos, CA 95032-1416 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/07/2006 |
Last Update Date | 08/03/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
A32812 | (02) | CA |