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General NPI Number Information
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NPI Number | 1497953921
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Entity Type | Organization
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Legal Business Name | BLYNN L SHIDELER MD PC
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Dates
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Enumeration Date | 07/05/2007
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Last Update Date | 03/04/2008
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Provider Practice Location Address
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Address Line | 5 LOWER RAGSDALE DR SUITE 101
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City | MONTEREY
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State | CA
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Zip | 93940-5817
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Country | US
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Telephone | 425-996-1001
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Fax | 206-600-5033
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Provider Business Mailing Address
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Address Line | 1420 NW GILMAN BLVD SUITE 2 2786
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City | ISSAQUAH
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State | WA
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Zip | 98027-5394
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | BLYNN L SHIDELER
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Credential | MD
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Telephone | 425-996-1001
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | MD00045810
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License Number State | WA
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Taxonomy #2
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | G23099
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License Number State | CA
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