Provider Demographics
NPI:1578515441
Name:SHAW, DANIEL WOODSON (MD)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:WOODSON
Last Name:SHAW
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:200 WEST ARBOR DR
Mailing Address - Street 2:UCSD MEDICAL CENTER - DERMATOLOGY - MC 8420
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92103-8420
Mailing Address - Country:US
Mailing Address - Phone:619-543-3626
Mailing Address - Fax:619-741-6655
Practice Address - Street 1:200 WEST ARBOR DR
Practice Address - Street 2:UCSD MEDICAL CENTER - DERMATOLOGY - MC 8420
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92103-8420
Practice Address - Country:US
Practice Address - Phone:619-543-3626
Practice Address - Fax:619-741-6655
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-17
Last Update Date:2007-07-08
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Provider Licenses
StateLicense IDTaxonomies
CAG59947207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G599470Medicaid
CAWG59947AMedicare ID - Type Unspecified
CA00G599470Medicaid