Provider Demographics
NPI:1487643102
Name:CHOW, SHIRLEY H (MD)
Entity Type:Individual
Prefix:
First Name:SHIRLEY
Middle Name:H
Last Name:CHOW
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1125 E SOUTHERN AVE
Mailing Address - Street 2:SUITE 300
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85204-5045
Mailing Address - Country:US
Mailing Address - Phone:480-545-8119
Mailing Address - Fax:480-892-6805
Practice Address - Street 1:1125 E SOUTHERN AVE
Practice Address - Street 2:SUITE 300
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85204-5045
Practice Address - Country:US
Practice Address - Phone:480-545-8119
Practice Address - Fax:480-892-6805
Is Sole Proprietor?:No
Enumeration Date:2005-10-14
Last Update Date:2011-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ265642085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ428624Medicaid
22847Medicare ID - Type UnspecifiedEVDI
AZ428624Medicaid
22848Medicare ID - Type UnspecifiedARL
61678Medicare ID - Type UnspecifiedDOMRI