Provider Demographics
NPI:1306950951
Name:ROGER W. SHORTZ, MD A PROFESSIONAL CORPORATION
Entity type:Organization
Organization Name:ROGER W. SHORTZ, MD A PROFESSIONAL CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROGER
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:SHORTZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD, FACS
Authorized Official - Phone:510-243-2130
Mailing Address - Street 1:140 GREGORY LN STE 210
Mailing Address - Street 2:
Mailing Address - City:PLEASANT HILL
Mailing Address - State:CA
Mailing Address - Zip Code:94523-3357
Mailing Address - Country:US
Mailing Address - Phone:510-243-2130
Mailing Address - Fax:510-243-2135
Practice Address - Street 1:140 GREGORY LN STE 210
Practice Address - Street 2:
Practice Address - City:PLEASANT HILL
Practice Address - State:CA
Practice Address - Zip Code:94523-3357
Practice Address - Country:US
Practice Address - Phone:510-243-2130
Practice Address - Fax:510-243-2135
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-19
Last Update Date:2025-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207LP2900X, 207T00000X
CAPT25842208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Multi-Specialty
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Multi-Specialty
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1437170651OtherINDIVIDUAL NPI #
CA00C359990Medicare ID - Type Unspecified
CA1437170651OtherINDIVIDUAL NPI #