Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Y00000X | Otolaryngologist (ENT Doctor) | G10966 | CA |
NPI | 1033180211 |
---|---|
Provider Name | Dr. George William Shorago |
First Address | San Mateo, CA 94401-3857 |
Second Address | San Mateo, CA 94401-3857 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/01/2006 |
Last Update Date | 04/02/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
A38146 | (02) |