Provider Demographics
NPI:1467629113
Name:SHAW, CATHRYN JOHNSON (MD)
Entity Type:Individual
Prefix:DR
First Name:CATHRYN
Middle Name:JOHNSON
Last Name:SHAW
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 911230
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75391-1230
Mailing Address - Country:US
Mailing Address - Phone:214-841-3010
Mailing Address - Fax:
Practice Address - Street 1:712 N WASHINGTON AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75246-1619
Practice Address - Country:US
Practice Address - Phone:214-841-3010
Practice Address - Fax:214-826-9792
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-13
Last Update Date:2015-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXP47112085R0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX314893403Medicaid
TX314893404Medicaid
TXP01389243OtherRAILROAD MEDICARE
TX314893403Medicaid
TX260439YM09Medicare PIN