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NPI Code Detail

MEDICARE: ROBERT W. SHAW III MD

MEDICARE: ROBERT W. SHAW III MD
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
1207R00000XInternal Medicine Physician20242KY

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
5110139027OTHERKYRAILROAD MEDICARE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
11054774OTHERKYPASSPORT
2008909OTHERKYSIHO
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4000000050956OTHERKYANTHEM
62538067OTHERKYCIGNA
72433724000OTHERKYPASSPORT ADVANTAGE
8MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
9000023028FOTHERKYHUMANA
1010806119OTHERKYCAQH

General Provider Information

NPI Number : 1285699827
Entity Type Code : Individual
Provider Name (Legal Business Name) : ROBERT W. SHAW III MD
Provider Business Mailing Address
First Line : PO BOX 776351
Second Line :
City : CHICAGO
State : IL
Zip : 60677-6351
Country : US
Telephone Number : 502-588-9490
Fax Number : 502-272-5116
Provider Business Practice Location Address
First Line : 825 BARRET AVE
Second Line :
City : LOUISVILLE
State : KY
Zip : 40204-1743
Country : US
Telephone Number : 502-540-7200
Fax Number : 502-540-7207
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/18/2006
Last Update Date : 07/14/2016

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