MEDICARE: JOHN A. 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	2085R0001X	Radiation Oncology Physician	14068	AZ
2	2085R0001X	Radiation Oncology Physician	MD60299819	WA

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
2	14068	OTHER	AZ	STATE LICENSE

General Provider Information

NPI Number	:	1518969021
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHN A. SHAW MD

Provider Business Mailing Address
First Line	:	PO BOX 3649
Second Line	:
City	:	SPOKANE
State	:	WA
Zip	:	99220-3649
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	12410 E SINTO AVE STE B
Second Line	:
City	:	SPOKANE VALLEY
State	:	WA
Zip	:	99216-2280
Country	:	US
Telephone Number	:	509-838-2531
Fax Number	:

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

Provider Enumeration Date	:	08/15/2005
Last Update Date	:	03/07/2023

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