Active NPI
Gary Nishioka, MD
- Otolaryngology Physician
- Salem, OR
National Provider Identifier
1861497034
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Otolaryngology Physician
- License
- 20787
- Practice address
- 3099 River Rd S
Salem, OR 97302-9754 - Phone
- (503) 581-1567
- Fax
- (503) 399-1229
- NPI assigned
- Jun 15, 2005
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Otolaryngology Physician | 207Y00000X | 20787 | OR | Primary |
Addresses
Primary practice location
3099 River Rd S
Salem, OR 97302-9754
Mailing address
3099 River Rd S
Salem, OR 97302-9754
Phone (503) 581-1567
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 150756 | Medicaid | OR |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 20787 | OR | MD | Otolaryngology Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1118793600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1320019200000",
"number": "1861497034",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3099 RIVER RD S",
"city": "SALEM",
"state": "OR",
"postal_code": "973029754",
"telephone_number": "503-581-1567",
"fax_number": "503-399-1229"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3099 RIVER RD S",
"city": "SALEM",
"state": "OR",
"postal_code": "973029754",
"telephone_number": "503-581-1567",
"fax_number": "503-399-1229"
}
],
"practiceLocations": [],
"basic": {
"last_name": "NISHIOKA",
"first_name": "GARY",
"name_prefix": "Dr.",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-06-15",
"last_updated": "2011-10-31",
"status": "A"
},
"taxonomies": [
{
"code": "207Y00000X",
"taxonomy_group": "",
"desc": "Otolaryngology",
"state": "OR",
"license": "20787",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "150756",
"state": "OR"
}
],
"endpoints": [],
"other_names": []
}Other providers in Salem, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 31, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.