Provider Demographics
NPI:1326294042
Name:MITCHELL SHAW P A
Entity Type:Organization
Organization Name:MITCHELL SHAW P A
Other - Org Name:MITCHELL J. SHAW, D.O. PA.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MITCHELL
Authorized Official - Middle Name:J
Authorized Official - Last Name:SHAW
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:239-394-4111
Mailing Address - Street 1:19 BALD EAGLE DR
Mailing Address - Street 2:SUITE B
Mailing Address - City:MARCO ISLAND
Mailing Address - State:FL
Mailing Address - Zip Code:34145-3580
Mailing Address - Country:US
Mailing Address - Phone:239-394-4111
Mailing Address - Fax:
Practice Address - Street 1:19 BALD EAGLE DR
Practice Address - Street 2:SUITE B
Practice Address - City:MARCO ISLAND
Practice Address - State:FL
Practice Address - Zip Code:34145-3580
Practice Address - Country:US
Practice Address - Phone:239-394-4111
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-13
Last Update Date:2008-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty