Healthcare Provider Details

I. General information

NPI: 1508078627
Provider Name (Legal Business Name): JOHN M SHIMA MD PS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/03/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

460 WEST E ST
FORKS WA
98331
US

IV. Provider business mailing address

460 WEST E ST
FORKS WA
98331
US

V. Phone/Fax

Practice location:
  • Phone: 360-374-2500
  • Fax:
Mailing address:
  • Phone: 360-374-2500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RS0012X
TaxonomySleep Medicine (Internal Medicine) Physician
License NumberMD00019175
License Number StateWA

VIII. Authorized Official

Name: MRS. MARGARET M SHIMA
Title or Position: OFFICE MANAGER
Credential:
Phone: 360-374-2500