Provider Demographics
NPI:1467775239
Name:ROBERT H SHAW M D A PROFESSIONAL CORP
Entity Type:Organization
Organization Name:ROBERT H SHAW M D A PROFESSIONAL CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAW
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-273-2686
Mailing Address - Street 1:9001 WILSHIRE BLVD
Mailing Address - Street 2:STE 104
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90211-1838
Mailing Address - Country:US
Mailing Address - Phone:310-273-2686
Mailing Address - Fax:310-385-9122
Practice Address - Street 1:9001 WILSHIRE BLVD
Practice Address - Street 2:STE 104
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90211-1838
Practice Address - Country:US
Practice Address - Phone:310-273-2686
Practice Address - Fax:310-385-9122
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-09
Last Update Date:2010-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA000G94550Medicaid
CV453AMedicare PIN
A58912Medicare UPIN