Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Y00000X | Otolaryngologist (ENT Doctor) | MD60489025 | WA |
N | 207YX0905X | Otolaryngology/Facial Plastic Surgery | MD60489025 | WA |
NPI | 1003928896 |
---|---|
Provider Name | Shane A Zim |
First Address | Spokane, WA 99210-2242 |
Second Address | Spokane, WA 99201-2217 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/08/2006 |
Last Update Date | 16/12/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2047218 | (05) | WA |