Provider Demographics
NPI:1992758981
Name:SHIBAYAMA, JURIS (MD)
Entity type:Individual
Prefix:
First Name:JURIS
Middle Name:
Last Name:SHIBAYAMA
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:PO BOX 306556
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37230-6556
Mailing Address - Country:US
Mailing Address - Phone:865-243-8153
Mailing Address - Fax:
Practice Address - Street 1:300 STONECREST BLVD STE 300
Practice Address - Street 2:
Practice Address - City:SMYRNA
Practice Address - State:TN
Practice Address - Zip Code:37167-6801
Practice Address - Country:US
Practice Address - Phone:615-267-6600
Practice Address - Fax:615-267-6603
Is Sole Proprietor?:No
Enumeration Date:2006-05-18
Last Update Date:2023-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN41112207XS0117X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the Spine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3035065Medicaid
TNI54087Medicare UPIN
TN3035065Medicare PIN