Provider Demographics
NPI:1730157892
Name:TOLIVER, GEORGE SHAYNE (DO)
Entity type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:SHAYNE
Last Name:TOLIVER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:1111 W SPRUCE ST
Mailing Address - Street 2:STE 22
Mailing Address - City:YAKIMA
Mailing Address - State:WA
Mailing Address - Zip Code:98902-3257
Mailing Address - Country:US
Mailing Address - Phone:509-248-6414
Mailing Address - Fax:509-902-1099
Practice Address - Street 1:1111 W SPRUCE ST
Practice Address - Street 2:STE 22
Practice Address - City:YAKIMA
Practice Address - State:WA
Practice Address - Zip Code:98902-3257
Practice Address - Country:US
Practice Address - Phone:509-248-6414
Practice Address - Fax:509-902-1099
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-14
Last Update Date:2016-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOP00001397207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1119254Medicaid
WA1119254Medicaid
F15122Medicare UPIN