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Organization
PHILIP S SHORE M D INC
Active
Organization
PHILIP S SHORE M D INC
Active
Parent organization
PHILIP S. SHORE, M.D. INC.
Other names
SHORE TO SHORE MEDICAL GROUP
Organization subpart
Yes
Provider details
NPI number
Legal business name
PHILIP S. SHORE, M.D. INC.
Authorized official
PHILIP S SHORE MD (MD)
(818) 886-1100
Entity
Organization
Contact information
Practice address
18546 ROSCOE BLVD, SUITE 302, NORTHRIDGE, CA 91324-4663
(818) 886-1100
(818) 886-7501
Mailing address
18546 ROSCOE BLVD, SUITE 302, NORTHRIDGE, CA 91324-4663
(818) 886-1100
(818) 886-7501
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
G071824
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00G718240
BLUE SHIELD
CA
Enumeration date
07/19/2006
Last updated
06/22/2015
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