Organization
ENT SPECIALISTS, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RUSSELL S SHU MD (PRESIDENT)
(508) 588-8034
Entity
Organization
Contact information
Practice address
35 PEARL ST STE 100, BROCKTON, MA 02301-1195
(508) 588-8034
(508) 588-5969
Mailing address
35 PEARL ST STE 100, BROCKTON, MA 02301-1195
(508) 588-8034
(508) 588-5969
Taxonomy
Speciality
Code
Description
License number
State
207Y00000X
Otolaryngology Physician
Primary
—
—
225100000X
Physical Therapist
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
9700226
—
MA
01
—
M10815
BCBS OF MA -GRP ID#
MA
Enumeration date
01/09/2007
Last updated
12/18/2018
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