Provider Demographics
NPI:1437170651
Name:SHORTZ, ROGER WILLIAM (MD, FACS)
Entity Type:Individual
Prefix:DR
First Name:ROGER
Middle Name:WILLIAM
Last Name:SHORTZ
Suffix:
Gender:M
Credentials:MD, FACS
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:3065 RICHMOND PKWY
Mailing Address - Street 2:SUITE 102
Mailing Address - City:RICHMOND
Mailing Address - State:CA
Mailing Address - Zip Code:94806-5719
Mailing Address - Country:US
Mailing Address - Phone:510-243-2130
Mailing Address - Fax:510-243-2135
Practice Address - Street 1:3065 RICHMOND PKWY
Practice Address - Street 2:SUITE 102
Practice Address - City:RICHMOND
Practice Address - State:CA
Practice Address - Zip Code:94806-5719
Practice Address - Country:US
Practice Address - Phone:510-243-2130
Practice Address - Fax:510-243-2135
Is Sole Proprietor?:No
Enumeration Date:2006-07-22
Last Update Date:2008-01-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAC35999207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00C359990Medicare ID - Type Unspecified
CA00C359991Medicare PIN
CAA36135Medicare UPIN