Provider Demographics
NPI:1326038399
Name:SHAW, JEFFREY GORDON (MS)
Entity Type:Individual
Prefix:MR
First Name:JEFFREY
Middle Name:GORDON
Last Name:SHAW
Suffix:
Gender:M
Credentials:MS
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Mailing Address - Street 1:2222 N NEVADA AVE
Mailing Address - Street 2:CANCER ADMINISTRATION
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80907-6819
Mailing Address - Country:US
Mailing Address - Phone:719-776-5274
Mailing Address - Fax:719-776-2609
Practice Address - Street 1:2222 N NEVADA AVE
Practice Address - Street 2:CANCER ADMINISTRATION
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80907-6831
Practice Address - Country:US
Practice Address - Phone:719-776-5274
Practice Address - Fax:719-776-2609
Is Sole Proprietor?:No
Enumeration Date:2005-10-21
Last Update Date:2009-09-14
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes170300000XOther Service ProvidersGenetic Counselor, MS