Basic Information
Provider Information
NPI: 1457476269
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: GAUR
FirstName: SHOBHANA
MiddleName:  
NamePrefix: DR.
NameSuffix:  
Credential: M.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 3649
Address2:  
City: SPOKANE
State: WA
PostalCode: 992203649
CountryCode: US
TelephoneNumber: 5098382531
FaxNumber: 5097556580
Practice Location
Address1: 800 W 5TH AVE
Address2:  
City: SPOKANE
State: WA
PostalCode: 992042803
CountryCode: US
TelephoneNumber: 5098382531
FaxNumber: 5097556580
Other Information
ProviderEnumerationDate: 03/20/2007
LastUpdateDate: 06/13/2013
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207R00000X57.010481OHN Allopathic & Osteopathic PhysiciansInternal Medicine 
207R00000XMD60224039WAY Allopathic & Osteopathic PhysiciansInternal Medicine 

No ID Information.


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