Provider Demographics
NPI:1003971904
Name:SHAW, DAVID PRESTON (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:PRESTON
Last Name:SHAW
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 5202
Mailing Address - Street 2:
Mailing Address - City:KENT
Mailing Address - State:WA
Mailing Address - Zip Code:98064-5202
Mailing Address - Country:US
Mailing Address - Phone:253-520-0158
Mailing Address - Fax:253-854-9860
Practice Address - Street 1:470 FRONT ST N
Practice Address - Street 2:
Practice Address - City:ISSAQUAH
Practice Address - State:WA
Practice Address - Zip Code:98027-2914
Practice Address - Country:US
Practice Address - Phone:425-392-0654
Practice Address - Fax:425-392-8979
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-22
Last Update Date:2012-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD000313342084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0037710OtherL & I NUMBER
WA1086719Medicaid
WAF68888Medicare UPIN
WAG000120882Medicare ID - Type Unspecified