MEDICARE: JOSEPH SHVIDLER M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207YS0123X	Facial Plastic Surgery Physician	MD 00047502	WA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0241810	OTHER	WA	STATE L&I
2	0267023	OTHER	WA	STATE L&I

General Provider Information

NPI Number	:	1245202175
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOSEPH SHVIDLER M.D.

Provider Business Mailing Address
First Line	:	4545 POINT FOSDICK DR NW
Second Line	:
City	:	GIG HARBOR
State	:	WA
Zip	:	98335-1700
Country	:	US
Telephone Number	:	253-530-8000
Fax Number	:

Provider Business Practice Location Address
First Line	:	4545 POINT FOSDICK DR NW
Second Line	:
City	:	GIG HARBOR
State	:	WA
Zip	:	98335-1700
Country	:	US
Telephone Number	:	253-530-8000
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/03/2006
Last Update Date	:	11/07/2014

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