Provider Demographics
NPI:1326024738
Name:SHIMOTAKAHARA, STEVEN GEORGE (MD)
Entity type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:GEORGE
Last Name:SHIMOTAKAHARA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1900 WOODLAND DR
Mailing Address - Street 2:
Mailing Address - City:COOS BAY
Mailing Address - State:OR
Mailing Address - Zip Code:97420-0000
Mailing Address - Country:US
Mailing Address - Phone:541-267-5151
Mailing Address - Fax:541-266-4513
Practice Address - Street 1:1900 WOODLAND DR
Practice Address - Street 2:
Practice Address - City:COOS BAY
Practice Address - State:OR
Practice Address - Zip Code:97420-0000
Practice Address - Country:US
Practice Address - Phone:541-267-5151
Practice Address - Fax:541-266-4513
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-16
Last Update Date:2010-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD18345207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR1407812365OtherNBMC GROUP NPI NUMBER
ORCD8723OtherRR MEDICARE GROUP PIN
ORR0000WFBTVOtherMEDICARE GROUP PIN NUMBER
OR040011398OtherRR MEDICARE PTAN NUMBER
OR055801Medicaid
ORR0000WFBTVOtherMEDICARE GROUP PIN NUMBER
OR040011398OtherRR MEDICARE PTAN NUMBER
ORR0000WFBTVOtherMEDICARE GROUP PIN NUMBER
OK0577260001Medicare NSC