Basic Information
Provider Information | |||||||||
NPI: | 1710955307 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | SHUSTER | ||||||||
FirstName: | JOHN | ||||||||
MiddleName: | K | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | M.D. | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 601 W 5TH AVE | ||||||||
Address2: | SUITE 400 | ||||||||
City: | SPOKANE | ||||||||
State: | WA | ||||||||
PostalCode: | 992042715 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 5093442663 | ||||||||
FaxNumber: | 5096249179 | ||||||||
Practice Location | |||||||||
Address1: | 601 W 5TH AVE | ||||||||
Address2: | SUITE 400 | ||||||||
City: | SPOKANE | ||||||||
State: | WA | ||||||||
PostalCode: | 992042715 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 5093442663 | ||||||||
FaxNumber: | 5096249179 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 03/09/2006 | ||||||||
LastUpdateDate: | 01/11/2010 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207XS0117X | MD00036590 | WA | Y |   | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Orthopaedic Surgery of the Spine | 207X00000X | MD00036590 | WA | N |   | Allopathic & Osteopathic Physicians | Orthopaedic Surgery |   |
ID Information
ID | Type | State | Issuer | Description | 0034606 | 05 | MT |   | MEDICAID | 379109600 | 01 | WA | OWCP | OTHER | 805241500 | 05 | ID |   | MEDICAID | 8229817 | 05 | WA |   | MEDICAID | 123388 | 01 | WA | DEPT OF LABOR & INDUSTRIE | OTHER | 89220026 | 01 | WA | CRIME VICTIMS | OTHER | KB780 | 01 | ID | BLUE CROSS OF ID | OTHER | SH7670 | 01 | WA | ASURIS NW HEALTH | OTHER | 000010004895 | 01 | ID | BLUE SHIELD OF IDAHO | OTHER | 14477 | 01 | WA | GROUP HEALTH NW | OTHER | 000010004892 | 01 | ID | REGENCE BLUE SHIELD OF ID | OTHER | 200031946 | 01 | WA | RR MEDICARE | OTHER |