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NPI Code Detail

MEDICARE: DR. STEPHEN G SHAW M.D.

MEDICARE: DR. STEPHEN G 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
1207K00000XAllergy & Immunology Physician233206NY
2207R00000XInternal Medicine Physician140998CA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1204117100OTHERNYPHCS
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3EMPIRE BCBSOTHERNY184SE1
49431055OTHERNYCIGNA

General Provider Information

NPI Number : 1780668392
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. STEPHEN G SHAW M.D.
Provider Business Mailing Address
First Line : 10333 EL CAMINO REAL
Second Line :
City : ATASCADERO
State : CA
Zip : 93422-5808
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 10333 EL CAMINO REAL
Second Line :
City : ATASCADERO
State : CA
Zip : 93422-5808
Country : US
Telephone Number : 805-468-2000
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/06/2005
Last Update Date : 02/25/2019

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Directions to “ DR. STEPHEN G SHAW M.D.” Practice Location

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