Provider Demographics
NPI:1689656266
Name:SHINKAWA, SIDNEY (MD)
Entity Type:Individual
Prefix:
First Name:SIDNEY
Middle Name:
Last Name:SHINKAWA
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:PO BOX 1219
Mailing Address - Street 2:
Mailing Address - City:BURNET
Mailing Address - State:TX
Mailing Address - Zip Code:78611-7219
Mailing Address - Country:US
Mailing Address - Phone:512-715-3000
Mailing Address - Fax:512-756-6405
Practice Address - Street 1:700 HWY 281 N
Practice Address - Street 2:
Practice Address - City:MARBLE FALLS
Practice Address - State:TX
Practice Address - Zip Code:78654-5106
Practice Address - Country:US
Practice Address - Phone:830-693-2600
Practice Address - Fax:830-693-9755
Is Sole Proprietor?:No
Enumeration Date:2005-11-18
Last Update Date:2011-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ2795207Q00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX164170601OtherMEDICAID (SITE - RHC)
TX458843OtherMEDICARE (SITE - RHC)
TX104141006Medicaid
TX164170601OtherMEDICAID (SITE - RHC)
TX8L22612Medicare PIN