Provider Demographics
NPI:1508047838
Name:SHAW, JOHN D (PA-C)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:D
Last Name:SHAW
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Gender:M
Credentials:PA-C
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Mailing Address - Street 1:4900 S MONACO ST
Mailing Address - Street 2:SUITE 210
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80237-3486
Mailing Address - Country:US
Mailing Address - Phone:303-789-2663
Mailing Address - Fax:303-788-4871
Practice Address - Street 1:799 E HAMPDEN AVE
Practice Address - Street 2:SUITE 400
Practice Address - City:ENGLEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80113-2700
Practice Address - Country:US
Practice Address - Phone:303-789-2663
Practice Address - Fax:303-788-4871
Is Sole Proprietor?:No
Enumeration Date:2007-11-15
Last Update Date:2019-07-31
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Provider Licenses
StateLicense IDTaxonomies
NY23 013684363AS0400X
COPA.0001905363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO21877572Medicaid
CO383914YMCJMedicare PIN
CO21877572Medicaid