Healthcare Provider Details

I. General information

NPI: 1073904835
Provider Name (Legal Business Name): TRAVIS SHAW MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/13/2015
Last Update Date: 02/16/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8730 STONY POINT PKWY SUITE 120
RICHMOND VA
23235-1970
US

IV. Provider business mailing address

8730 STONY POINT PKWY SUITE 120
RICHMOND VA
23235-1970
US

V. Phone/Fax

Practice location:
  • Phone: 804-775-4559
  • Fax: 804-212-2476
Mailing address:
  • Phone: 804-775-4559
  • Fax: 804-212-2476

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number0101245920
License Number StateVA

VIII. Authorized Official

Name: DR. TRAVIS SHAW
Title or Position: PRESIDENT
Credential: M.D.
Phone: 804-775-4559