Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RH0003X | Hematology & Oncology | C37008 | CA |
NPI | 1033156682 |
---|---|
Provider Name | Roger Shiffman |
First Address | Monterey, CA 93940-5750 |
Second Address | Monterey, CA 93940-5750 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/06/2006 |
Last Update Date | 15/01/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00C370080 | BCBS (01) | |
A36443 | (02) | |
GR0080140 | MEDICAID GROUP (01) | CA |
ZZZ13460Z | MEDICARE GROUP # (01) |