Healthcare Provider Details

I. General information

NPI: 1710928205
Provider Name (Legal Business Name): JAMES BURR SHAW MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/08/2006
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1680 S MELROSE DR SUITE 105
VISTA CA
92081-5472
US

IV. Provider business mailing address

7040 AVENIDA ENCINAS #104-248
CARLSBAD CA
92011-4652
US

V. Phone/Fax

Practice location:
  • Phone: 760-632-7246
  • Fax: 760-942-8878
Mailing address:
  • Phone: 760-632-7246
  • Fax: 760-942-8878

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License NumberA45657
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License NumberA45657
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: