Provider Demographics
NPI:1417057084
Name:SHAW, JAMES SIDNEY (DPM)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:SIDNEY
Last Name:SHAW
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:65 TETON LN
Mailing Address - Street 2:
Mailing Address - City:MANKATO
Mailing Address - State:MN
Mailing Address - Zip Code:56001-4814
Mailing Address - Country:US
Mailing Address - Phone:507-345-3347
Mailing Address - Fax:507-345-7040
Practice Address - Street 1:65 TETON LN
Practice Address - Street 2:
Practice Address - City:MANKATO
Practice Address - State:MN
Practice Address - Zip Code:56001-4814
Practice Address - Country:US
Practice Address - Phone:507-345-3347
Practice Address - Fax:507-345-7040
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-24
Last Update Date:2007-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN299213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN114354OtherUCARE
MN3875OtherMMSI
MNV41124916441171OtherHEALTH PARTNERS
MN41564SHOtherBLUE CROSS BLUE SHIELD
MN27-00637OtherMEDICA
MN41564SHOtherBLUE PLUS
MN935341018502OtherPREFERRED ONE
MN115435OtherCHOICE PLUS
MNV41124916441171OtherHEALTH PARTNERS
MN0334370001Medicare NSC
MN935341018502OtherPREFERRED ONE