Healthcare Provider Details

I. General information

NPI: 1003928896
Provider Name (Legal Business Name): SHANE A ZIM M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 12/16/2021
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

217 W CATALDO AVE
SPOKANE WA
99201-2217
US

IV. Provider business mailing address

PO BOX 2242
SPOKANE WA
99210-2242
US

V. Phone/Fax

Practice location:
  • Phone: 509-624-2326
  • Fax: 509-252-2837
Mailing address:
  • Phone: 509-624-2326
  • Fax: 509-252-2837

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207YX0905X
TaxonomyOtolaryngology/Facial Plastic Surgery Physician
License NumberMD60489025
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License NumberMD60489025
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: