Healthcare Provider Details

I. General information

NPI: 1871991000
Provider Name (Legal Business Name): TRAVIS SHAW MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/22/2014
Last Update Date: 12/22/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8730 STONY POINT PARKWAY STE 120
RICHMOND VA
23235
US

IV. Provider business mailing address

8730 STONY POINT PKWY STE 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 Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number0101245920
License Number StateVA

VIII. Authorized Official

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