MEDICARE: DR. PAUL C SHAW PSY.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	103TC0700X	Clinical Psychologist	847	AL

General Provider Information

NPI Number	:	1508197567
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PAUL C SHAW PSY.D

Provider Business Mailing Address
First Line	:	6346 GENE TERRY RD
Second Line	:
City	:	COTTONWOOD
State	:	AL
Zip	:	36320-4253
Country	:	US
Telephone Number	:	334-699-8743
Fax Number	:	334-699-8748

Provider Business Practice Location Address
First Line	:	6346 GENE TERRY RD
Second Line	:
City	:	COTTONWOOD
State	:	AL
Zip	:	36320-4253
Country	:	US
Telephone Number	:	334-699-8743
Fax Number	:	334-699-8748

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

Provider Enumeration Date	:	01/14/2010
Last Update Date	:	06/30/2011

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