Provider Demographics
NPI:1114240918
Name:STEPHEN R SHAUL MD INC PS
Entity Type:Organization
Organization Name:STEPHEN R SHAUL MD INC PS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:R
Authorized Official - Last Name:SHAUL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:509-966-0292
Mailing Address - Street 1:4601 AVALANCHE AVE
Mailing Address - Street 2:
Mailing Address - City:YAKIMA
Mailing Address - State:WA
Mailing Address - Zip Code:98908-2830
Mailing Address - Country:US
Mailing Address - Phone:509-966-0292
Mailing Address - Fax:
Practice Address - Street 1:4601 AVALANCHE AVE
Practice Address - Street 2:
Practice Address - City:YAKIMA
Practice Address - State:WA
Practice Address - Zip Code:98908-2830
Practice Address - Country:US
Practice Address - Phone:509-966-0292
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-08
Last Update Date:2013-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00011637261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty