Provider Demographics
NPI:1700892387
Name:SHIBATA, DAVID (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:SHIBATA
Suffix:
Gender:M
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 1000
Mailing Address - Street 2:DEPT # 457
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38148-0457
Mailing Address - Country:US
Mailing Address - Phone:901-609-3520
Mailing Address - Fax:901-266-6415
Practice Address - Street 1:1211 UNION AVE
Practice Address - Street 2:SUITE 300
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38104-6638
Practice Address - Country:US
Practice Address - Phone:901-609-3520
Practice Address - Fax:901-266-6415
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2015-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME914192086X0206X
TN533262086X0206X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086X0206XAllopathic & Osteopathic PhysiciansSurgerySurgical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ014867Medicaid
FL50092ZMedicare PIN
FL270773000Medicaid
FLH29397Medicare UPIN
FLP00172622Medicare PIN