Provider Demographics
NPI:1043243058
Name:SHOPTAW, GEORGE L (MD)
Entity Type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:L
Last Name:SHOPTAW
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 W PARR AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:LOS GATOS
Mailing Address - State:CA
Mailing Address - Zip Code:95032-1442
Mailing Address - Country:US
Mailing Address - Phone:408-374-7880
Mailing Address - Fax:408-374-4097
Practice Address - Street 1:700 W PARR AVE
Practice Address - Street 2:SUITE B
Practice Address - City:LOS GATOS
Practice Address - State:CA
Practice Address - Zip Code:95032-1416
Practice Address - Country:US
Practice Address - Phone:408-374-7880
Practice Address - Fax:408-374-4097
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-10
Last Update Date:2011-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC025174207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAOOC251740Medicare ID - Type Unspecified
CAA32812Medicare UPIN