Basic Information
| Provider Information | |||||||||
| NPI: | 1548238314 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SHINA | ||||||||
| FirstName: | DONALD | ||||||||
| MiddleName: | C | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 455 SAINT MICHAELS DR | ||||||||
| Address2: | PHYSICIAN PRACTICES, ATTN: CARLA GOMEZ | ||||||||
| City: | SANTA FE | ||||||||
| State: | NM | ||||||||
| PostalCode: | 875057601 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5058205227 | ||||||||
| FaxNumber: | 5058205645 | ||||||||
| Practice Location | |||||||||
| Address1: | 455 SAINT MICHAELS DR | ||||||||
| Address2: | |||||||||
| City: | SANTA FE | ||||||||
| State: | NM | ||||||||
| PostalCode: | 875057601 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5058205233 | ||||||||
| FaxNumber: | 5059896466 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/09/2006 | ||||||||
| LastUpdateDate: | 01/21/2009 | ||||||||
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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 | 2085R0001X | 98-165 | NM | Y | Allopathic & Osteopathic Physicians | Radiology | Radiation Oncology |
ID Information
| ID | Type | State | Issuer | Description | 26881829 | 05 | NM | MEDICAID | 621451 | 01 | UHC | OTHER | NM009X50 | 01 | NM | BCBS NM | OTHER | PROVP15993 | 01 | MOLINA | OTHER | 10003247 | 01 | LOVELACE | OTHER | 1469314 | 01 | CCN | OTHER | 202000031 | 01 | PRESBYTERIAN HEALTH PLANS | OTHER |