Provider Demographics
NPI:1366474710
Name:SHAW, ROBERT C JR (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:C
Last Name:SHAW
Suffix:JR
Gender:M
Credentials:MD
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Mailing Address - Street 1:1098 S STATE ROAD 25
Mailing Address - Street 2:
Mailing Address - City:LOGANSPORT
Mailing Address - State:IN
Mailing Address - Zip Code:46947-6723
Mailing Address - Country:US
Mailing Address - Phone:574-722-4141
Mailing Address - Fax:574-735-3414
Practice Address - Street 1:1098 S STATE ROAD 25
Practice Address - Street 2:
Practice Address - City:LOGANSPORT
Practice Address - State:IN
Practice Address - Zip Code:46947-6723
Practice Address - Country:US
Practice Address - Phone:574-722-4141
Practice Address - Fax:574-735-3414
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IN01061706A2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry