Provider Demographics
NPI:1669648697
Name:ROBERT J SHORR MD MEDICAL CORP
Entity Type:Organization
Organization Name:ROBERT J SHORR MD MEDICAL CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:J
Authorized Official - Last Name:SHORR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:818-776-9555
Mailing Address - Street 1:PO BOX 571651
Mailing Address - Street 2:18455 BURBANK BLVD #105
Mailing Address - City:TARZANA
Mailing Address - State:CA
Mailing Address - Zip Code:91356
Mailing Address - Country:US
Mailing Address - Phone:818-776-9555
Mailing Address - Fax:818-776-8883
Practice Address - Street 1:2781 LOMA VISTA RD STE B
Practice Address - Street 2:
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93003-1577
Practice Address - Country:US
Practice Address - Phone:805-715-1041
Practice Address - Fax:818-776-8883
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-30
Last Update Date:2012-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG344392084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA91599Medicare UPIN
CAG34439Medicare PIN