MEDICARE: DR. HOLLIS EARL SHAW M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RH0003X	Hematology & Oncology Physician	15515	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1104890680
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. HOLLIS EARL SHAW M.D.

Provider Business Mailing Address
First Line	:	6242 E ARBOR AVE
Second Line	:	SUITE 116
City	:	MESA
State	:	AZ
Zip	:	85206-1309
Country	:	US
Telephone Number	:	480-668-7060
Fax Number	:	480-668-5815

Provider Business Practice Location Address
First Line	:	6242 E ARBOR AVE
Second Line	:	SUITE 116
City	:	MESA
State	:	AZ
Zip	:	85206-1309
Country	:	US
Telephone Number	:	480-668-7060
Fax Number	:	480-668-5815

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/14/2006
Last Update Date	:	01/15/2016

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