MEDICARE: DAVID L SHAW M.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	207R00000X	Internal Medicine Physician	108388	MO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	7486026	OTHER	MO	AETNA
2	138767	OTHER	MO	GHP
3	000000010051	OTHER	MO	ESSENCE
4	116062	OTHER	MO	BCBS
5	407737	OTHER	MO	HEALTLINK
6	G73848	OTHER	MO	MERCY
7	0406305	OTHER	MO	UHC
8	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1669454500
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAVID L SHAW M.D.

Provider Business Mailing Address
First Line	:	PO BOX 23340
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63156-3340
Country	:	US
Telephone Number	:	314-355-1660
Fax Number	:	314-355-2807

Provider Business Practice Location Address
First Line	:	11155 DUNN RD
Second Line	:	SUITE 205E
City	:	SAINT LOUIS
State	:	MO
Zip	:	63136-6150
Country	:	US
Telephone Number	:	314-355-1660
Fax Number	:	314-355-2807

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

Provider Enumeration Date	:	11/16/2005
Last Update Date	:	09/28/2012

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Directions to “ DAVID L SHAW M.D.” Practice Location

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