Provider Demographics
NPI:1275578916
Name:STEPHEN R. SHAW, M.D., INC.
Entity Type:Organization
Organization Name:STEPHEN R. SHAW, M.D., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:JOANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:FORLAW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:805-642-0128
Mailing Address - Street 1:3418 LOMA VISTA RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93003-3016
Mailing Address - Country:US
Mailing Address - Phone:805-642-0128
Mailing Address - Fax:805-656-3421
Practice Address - Street 1:3418 LOMA VISTA RD
Practice Address - Street 2:SUITE B
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93003-3016
Practice Address - Country:US
Practice Address - Phone:805-642-0128
Practice Address - Fax:805-656-3421
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG47926207XS0117X
CAG50864208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the SpineGroup - Multi-Specialty
Not Answered208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA50864Medicare UPIN