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NPI Code Detail

MEDICARE: BOBBY SHAW MD LLC

MEDICARE: BOBBY SHAW MD LLC
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
1207Q00000XFamily Medicine Physician

General Provider Information

NPI Number : 1992349369
Entity Type Code : Organization
Provider Name (Legal Business Name) : BOBBY SHAW MD LLC
Provider Business Mailing Address
First Line : 3055 SAINT ROSE PKWY # 777905
Second Line :
City : HENDERSON
State : NV
Zip : 89052-3889
Country : US
Telephone Number : 702-453-3799
Fax Number : 702-453-5741
Provider Business Practice Location Address
First Line : 2930 SIENA HEIGHTS DR
Second Line :
City : HENDERSON
State : NV
Zip : 89052-3871
Country : US
Telephone Number : 702-453-3799
Fax Number : 702-453-5741
Authorized Official
Title or Position : SOLE OWNER
Name : PRIYA SHAW
Credential : M.D.
Telephone Number : 702-840-8674
Provider Enumeration Date : 10/29/2019
Last Update Date : 03/23/2023

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