Provider Demographics
NPI:1336120419
Name:SHAW, DAVID M (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:M
Last Name:SHAW
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1700 SPRING HILL AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36604-1407
Mailing Address - Country:US
Mailing Address - Phone:251-435-1200
Mailing Address - Fax:251-435-6357
Practice Address - Street 1:1700 SPRING HILL AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36604-1407
Practice Address - Country:US
Practice Address - Phone:251-435-1200
Practice Address - Fax:251-435-6357
Is Sole Proprietor?:No
Enumeration Date:2005-11-07
Last Update Date:2012-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL18111207RC0000X, 207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00114799Medicaid
AL000033295Medicaid
AL33295Medicare ID - Type UnspecifiedALABAMA MEDICARE
MS00114799Medicaid
MS060000219Medicare ID - Type UnspecifiedMISSISSIPPI MEDICARE