Provider Demographics
NPI:1073527198
Name:SHOOR, PERRY MICHAEL (MD)
Entity Type:Individual
Prefix:DR
First Name:PERRY
Middle Name:MICHAEL
Last Name:SHOOR
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 1:80 SUTHERLAND DR
Mailing Address - Street 2:
Mailing Address - City:ATHERTON
Mailing Address - State:CA
Mailing Address - Zip Code:94027-6430
Mailing Address - Country:US
Mailing Address - Phone:650-854-3578
Mailing Address - Fax:650-854-3643
Practice Address - Street 1:1303 SAN CARLOS AVE
Practice Address - Street 2:
Practice Address - City:SAN CARLOS
Practice Address - State:CA
Practice Address - Zip Code:94070-2317
Practice Address - Country:US
Practice Address - Phone:650-593-0965
Practice Address - Fax:650-593-2379
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-27
Last Update Date:2008-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG240442086S0129X, 2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACP2153OtherRAILROAD MEDICARE
CACP2153OtherRAILROAD MEDICARE
CAA42143Medicare UPIN