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General NPI Number Information
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NPI Number | 1811217219
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Entity Type | Organization
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Legal Business Name | GEORGE W SHORAGO, MD, INC
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Dates
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Enumeration Date | 06/08/2010
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Last Update Date | 06/08/2010
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Provider Practice Location Address
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Address Line | 1303 SAN CARLOS AVE
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City | SAN CARLOS
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State | CA
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Zip | 94070-2317
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Country | US
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Telephone | 650-508-8287
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Fax | 650-593-2379
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Provider Business Mailing Address
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Address Line | 1303 SAN CARLOS AVE
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City | SAN CARLOS
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State | CA
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Zip | 94070-2317
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Country | US
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Telephone | 650-508-8287
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Fax | 650-593-2379
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. GEORGE W SHORAGO
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Credential | M.D.
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Telephone | 650-508-8287
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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 | G10966
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License Number State | CA
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