Organization
BLYNN L SHIDELER MD PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BLYNN L SHIDELER MD (PRESIDENT)
(425) 996-1001
Entity
Organization
Contact information
Practice address
5 LOWER RAGSDALE DR, SUITE 101, MONTEREY, CA 93940-5817
(425) 996-1001
(206) 600-5033
Mailing address
1420 NW GILMAN BLVD, SUITE 2 2786, ISSAQUAH, WA 98027-5394
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
G23099
CA
208600000X
Surgery Physician
MD00045810
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1265524912
NPI FOR INDIVIDUAL
—
05
—
9670018
—
CA
Enumeration date
07/05/2007
Last updated
03/04/2008
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