Provider Demographics
NPI:1588801229
Name:SHAW, BETSY ALCID (MD)
Entity Type:Individual
Prefix:DR
First Name:BETSY
Middle Name:ALCID
Last Name:SHAW
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1001 WEST CARSON STREET
Mailing Address - Street 2:SUITE I
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90502-2051
Mailing Address - Country:US
Mailing Address - Phone:310-533-9233
Mailing Address - Fax:310-533-9292
Practice Address - Street 1:1001 WEST CARSON STREET
Practice Address - Street 2:SUITE I
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90502-2051
Practice Address - Country:US
Practice Address - Phone:310-533-9233
Practice Address - Fax:310-533-9292
Is Sole Proprietor?:No
Enumeration Date:2009-01-16
Last Update Date:2016-03-10
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAA42535207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A425350Medicaid
CAA-29599Medicare UPIN