MEDICARE: VINCENT LEE SHAW JR. 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	207QS0010X	Sports Medicine (Family Medicine) Physician	026422	LA
2	207Q00000X	Family Medicine Physician	026422	LA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	4J728YJGU	OTHER	LA	MEDICARE PTAN

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
2	026422	OTHER	LA	LA STATE LICENSE #

General Provider Information

NPI Number	:	1154356491
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VINCENT LEE SHAW JR. MD

Provider Business Mailing Address
First Line	:	8490 PICARDY AVE
Second Line	:	BLDG 200
City	:	BATON ROUGE
State	:	LA
Zip	:	70809-3731
Country	:	US
Telephone Number	:	225-237-1754
Fax Number	:	225-237-1722

Provider Business Practice Location Address
First Line	:	3604 NICHOLSON DR STE 3
Second Line	:
City	:	BATON ROUGE
State	:	LA
Zip	:	70802-8602
Country	:	US
Telephone Number	:	225-765-5500
Fax Number	:	225-374-9104

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

Provider Enumeration Date	:	07/12/2006
Last Update Date	:	09/09/2025

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Directions to “ VINCENT LEE SHAW JR. MD” Practice Location

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