Individual
DR. STEVEN GEORGE SHIMOTAKAHARA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1900 WOODLAND DR, COOS BAY, OR 97420-0000
(541) 267-5151
(541) 266-4513
Mailing address
1900 WOODLAND DR, COOS BAY, OR 97420-0000
(541) 267-5151
(541) 266-4513
Taxonomy
Speciality
Code
Description
License number
State
207Y00000X
Otolaryngology Physician
Primary
MD18345
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
040011398
RR MEDICARE PTAN NUMBER
OR
05
—
055801
—
OR
01
—
1407812365
NBMC GROUP NPI NUMBER
OR
01
—
CD8723
RR MEDICARE GROUP PIN
OR
01
—
R0000WFBTV
MEDICARE GROUP PIN NUMBER
OR
Enumeration date
12/16/2005
Last updated
03/23/2010
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