Provider Demographics
NPI:1831254499
Name:OHN, SHIRLEY (MD)
Entity type:Individual
Prefix:DR
First Name:SHIRLEY
Middle Name:
Last Name:OHN
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 1:919 12TH PL STE 6
Mailing Address - Street 2:
Mailing Address - City:PRESCOTT
Mailing Address - State:AZ
Mailing Address - Zip Code:86305-1433
Mailing Address - Country:US
Mailing Address - Phone:928-445-4166
Mailing Address - Fax:928-776-9668
Practice Address - Street 1:919 12TH PL STE 6
Practice Address - Street 2:
Practice Address - City:PRESCOTT
Practice Address - State:AZ
Practice Address - Zip Code:86305-1433
Practice Address - Country:US
Practice Address - Phone:928-445-4166
Practice Address - Fax:928-776-9668
Is Sole Proprietor?:No
Enumeration Date:2006-12-26
Last Update Date:2011-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ13862207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ228975Medicaid
AZWCLHW02Medicare ID - Type Unspecified
AZ228975Medicaid