Healthcare Provider Details

I. General information

NPI: 1154356491
Provider Name (Legal Business Name): VINCENT LEE SHAW JR. MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2006
Last Update Date: 09/09/2025
Certification Date: 09/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3604 NICHOLSON DR STE 3
BATON ROUGE LA
70802-8602
US

IV. Provider business mailing address

8490 PICARDY AVE BLDG 200
BATON ROUGE LA
70809-3731
US

V. Phone/Fax

Practice location:
  • Phone: 225-765-5500
  • Fax: 225-374-9104
Mailing address:
  • Phone: 225-237-1754
  • Fax: 225-237-1722

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number026422
License Number StateLA
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number026422
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: