Healthcare Provider Details

I. General information

NPI: 1467775239
Provider Name (Legal Business Name): ROBERT H SHAW M D A PROFESSIONAL CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/09/2010
Last Update Date: 03/15/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9001 WILSHIRE BLVD STE 104
BEVERLY HILLS CA
90211-1838
US

IV. Provider business mailing address

9001 WILSHIRE BLVD STE 104
BEVERLY HILLS CA
90211-1838
US

V. Phone/Fax

Practice location:
  • Phone: 310-273-2686
  • Fax: 310-385-9122
Mailing address:
  • Phone: 310-273-2686
  • Fax: 310-385-9122

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. ROBERT SHAW
Title or Position: PRESIDENT
Credential: M.D.
Phone: 310-273-2686