Individual
SHILPA JOG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
3901 HOYT AVE, EVERETT, WA 98201-4918
(425) 339-5420
Mailing address
PO BOX 5127, EVERETT, WA 98206-5127
(425) 258-3900
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
MD00048506
WA
208000000X
Pediatrics Physician
MD00048506
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1057747
—
WA
01
—
MD00048506
STATE LICENSE
WA
Enumeration date
09/11/2007
Last updated
12/11/2012
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