Basic Information
| Provider Information | |||||||||
| NPI: | 1376613034 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SHEARER | ||||||||
| FirstName: | DOUGLAS | ||||||||
| MiddleName: | WILLIAM | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 577 | ||||||||
| Address2: | |||||||||
| City: | SUNNYSIDE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 989440577 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5098376911 | ||||||||
| FaxNumber: | 5098376920 | ||||||||
| Practice Location | |||||||||
| Address1: | 803 E LINCOLN AVE | ||||||||
| Address2: | |||||||||
| City: | SUNNYSIDE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 989442383 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5098376911 | ||||||||
| FaxNumber: | 5098376920 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/09/2006 | ||||||||
| LastUpdateDate: | 09/28/2009 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | MD00013930 | WA | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 8523334 | 05 | WA | MEDICAID |