Provider Demographics
NPI:1801817929
Name:SHASTA ENT SPECIALISTS
Entity Type:Organization
Organization Name:SHASTA ENT SPECIALISTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:H
Authorized Official - Last Name:DOMB
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:530-242-5600
Mailing Address - Street 1:2125 COURT ST
Mailing Address - Street 2:
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96001-2531
Mailing Address - Country:US
Mailing Address - Phone:530-242-5600
Mailing Address - Fax:530-242-5605
Practice Address - Street 1:2125 COURT ST
Practice Address - Street 2:
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96001-2531
Practice Address - Country:US
Practice Address - Phone:530-242-5600
Practice Address - Fax:530-242-5605
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-22
Last Update Date:2020-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ27849ZMedicare Oscar/Certification