MEDICARE: ALBERT LOVELL SHAW MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207LP2900X	Pain Medicine (Anesthesiology) Physician	D8080	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1073518833
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALBERT LOVELL SHAW MD

Provider Business Mailing Address
First Line	:	P.O. BOX 780
Second Line	:
City	:	COLLEYVILLE
State	:	TX
Zip	:	76034
Country	:	US
Telephone Number	:	817-868-1109
Fax Number	:	817-545-8266

Provider Business Practice Location Address
First Line	:	729 WEST BEDFORDEULESS ROAD
Second Line	:	SUITE 111
City	:	HURST
State	:	TX
Zip	:	76053
Country	:	US
Telephone Number	:	817-868-1109
Fax Number	:	817-545-8266

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/17/2005
Last Update Date	:	07/08/2010

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