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General NPI Number Information
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NPI Number | 1235115056
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Entity Type | Individual
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Provider Name | MICHAEL D SHAW D.O.
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Gender | Male
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Dates
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Enumeration Date | 12/22/2005
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Last Update Date | 07/01/2008
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Provider Practice Location Address
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Address Line | 400 HOSPITAL RD
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City | STARKVILLE
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State | MS
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Zip | 39759-2163
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Country | US
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Telephone | 662-615-2503
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Fax | 662-615-2554
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Provider Business Mailing Address
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Address Line | 400 HOSPITAL RD
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City | STARKVILLE
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State | MS
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Zip | 39759-2163
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Country | US
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Telephone | 662-615-2503
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Fax | 662-615-2554
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207PE0004X
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Taxonomy Name | Emergency Medical Services (Emergency Medicine) Physician
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License Number | 18567
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License Number State | MS
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