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NPI Code Detail

MEDICARE: MR. JEFFREY GORDON SHAW M.S.

MEDICARE: MR. JEFFREY GORDON SHAW M.S.
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
1170300000XGenetic Counselor (M.S.)

General Provider Information

NPI Number : 1326038399
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. JEFFREY GORDON SHAW M.S.
Provider Business Mailing Address
First Line : 2222 N NEVADA AVE
Second Line : CANCER ADMINISTRATION
City : COLORADO SPRINGS
State : CO
Zip : 80907-6819
Country : US
Telephone Number : 719-776-5274
Fax Number : 719-776-2609
Provider Business Practice Location Address
First Line : 2222 N NEVADA AVE
Second Line : CANCER ADMINISTRATION
City : COLORADO SPRINGS
State : CO
Zip : 80907-6831
Country : US
Telephone Number : 719-776-5274
Fax Number : 719-776-2609
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/21/2005
Last Update Date : 09/14/2009

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