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General NPI Number Information
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NPI Number | 1043243058
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Entity Type | Individual
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Provider Name | GEORGE L. SHOPTAW M.D.
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Gender | Male
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Dates
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Enumeration Date | 07/10/2006
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Last Update Date | 03/08/2011
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Provider Practice Location Address
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Address Line | 700 W PARR AVE SUITE B
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City | LOS GATOS
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State | CA
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Zip | 95032-1416
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Country | US
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Telephone | 408-374-7880
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Fax | 408-374-4097
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Provider Business Mailing Address
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Address Line | 700 W PARR AVE SUITE B
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City | LOS GATOS
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State | CA
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Zip | 95032-1442
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Country | US
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Telephone | 408-374-7880
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Fax | 408-374-4097
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Y00000X
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Taxonomy Name | Otolaryngology Physician
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License Number | C025174
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License Number State | CA
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