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General NPI Number Information
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NPI Number | 1801040688
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Entity Type | Organization
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Legal Business Name | JOHN R SHAW MD MEDICAL CORPORATION
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Dates
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Enumeration Date | 11/06/2008
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Last Update Date | 11/06/2008
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Provider Practice Location Address
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Address Line | 3719 ARLINGTON AVE SUITE 1
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City | RIVERSIDE
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State | CA
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Zip | 92506-2652
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Country | US
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Telephone | 951-781-3800
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Fax | 951-781-1973
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Provider Business Mailing Address
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Address Line | 3719 ARLINGTON AVE SUITE 1
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City | RIVERSIDE
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State | CA
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Zip | 92506-2652
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Country | US
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Telephone | 951-781-3800
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Fax | 951-781-1973
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JOHN ROBERT SHAW
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Credential | M.D.
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Telephone | 951-781-3800
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | G15265
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License Number State | CA
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