Healthcare Provider Details

I. General information

NPI: 1831254499
Provider Name (Legal Business Name): SHIRLEY OHN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/26/2006
Last Update Date: 03/01/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

919 12TH PL STE 6
PRESCOTT AZ
86305-1433
US

IV. Provider business mailing address

919 12TH PL STE 6
PRESCOTT AZ
86305-1433
US

V. Phone/Fax

Practice location:
  • Phone: 928-445-4166
  • Fax: 928-776-9668
Mailing address:
  • Phone: 928-445-4166
  • Fax: 928-776-9668

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number13862
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: