MEDICARE: DR. TRACY LYNNE SHAW 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
1	208000000X	Pediatrics Physician	35629	IA

General Provider Information

NPI Number	:	1306868526
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TRACY LYNNE SHAW MD

Provider Business Mailing Address
First Line	:	1345 GOLDENROD DR
Second Line	:
City	:	IOWA CITY
State	:	IA
Zip	:	52246-8628
Country	:	US
Telephone Number	:	319-341-0240
Fax Number	:

Provider Business Practice Location Address
First Line	:	605 E JEFFERSON ST
Second Line	:
City	:	IOWA CITY
State	:	IA
Zip	:	52245-2426
Country	:	US
Telephone Number	:	319-351-1448
Fax Number	:

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

Provider Enumeration Date	:	07/24/2006
Last Update Date	:	03/04/2019

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