Provider Demographics
NPI:1518226307
Name:LIBAW, SHAWN DONALD (MD)
Entity Type:Individual
Prefix:DR
First Name:SHAWN
Middle Name:DONALD
Last Name:LIBAW
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:293 S GRAND AVE
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91105-1623
Mailing Address - Country:US
Mailing Address - Phone:626-792-1120
Mailing Address - Fax:626-792-9100
Practice Address - Street 1:293 S GRAND AVE
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91105-1623
Practice Address - Country:US
Practice Address - Phone:626-792-1120
Practice Address - Fax:626-792-9100
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-14
Last Update Date:2012-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG47738207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine