Provider Demographics
NPI:1205871043
Name:FUJITA, SHIRO (MD)
Entity type:Individual
Prefix:DR
First Name:SHIRO
Middle Name:
Last Name:FUJITA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:SHIRO
Other - Middle Name:
Other - Last Name:FUJITA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:5171 COTTONWOOD ST
Mailing Address - Street 2:SUITE 650
Mailing Address - City:MURRAY
Mailing Address - State:UT
Mailing Address - Zip Code:84107-5704
Mailing Address - Country:US
Mailing Address - Phone:801-507-9600
Mailing Address - Fax:801-507-9601
Practice Address - Street 1:5171 COTTONWOOD ST
Practice Address - Street 2:SUITE 650
Practice Address - City:MURRAY
Practice Address - State:UT
Practice Address - Zip Code:84107-5704
Practice Address - Country:US
Practice Address - Phone:801-507-9600
Practice Address - Fax:801-507-9601
Is Sole Proprietor?:No
Enumeration Date:2006-06-17
Last Update Date:2010-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT7365628-1205204F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204F00000XAllopathic & Osteopathic PhysiciansTransplant Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL35555Medicare ID - Type Unspecified
H20706Medicare UPIN
FL35555ZMedicare PIN