Provider Demographics
NPI:1629056122
Name:SHAW, REBECCA D (MD)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:D
Last Name:SHAW
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6000 UNIVERSITY AVE
Mailing Address - Street 2:SUITE 203
Mailing Address - City:WEST DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50266-8203
Mailing Address - Country:US
Mailing Address - Phone:515-241-2200
Mailing Address - Fax:515-241-2202
Practice Address - Street 1:6000 UNIVERSITY AVE
Practice Address - Street 2:SUITE 203
Practice Address - City:WEST DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50266-8203
Practice Address - Country:US
Practice Address - Phone:515-241-2200
Practice Address - Fax:515-241-2202
Is Sole Proprietor?:No
Enumeration Date:2006-01-04
Last Update Date:2012-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA20305207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1629056122Medicaid
IA160035124OtherRR MEDICARE
IA1189175Medicaid
IA160030872OtherRR MEDICARE
IA2189175Medicaid
IA1189175Medicaid
IA160030872OtherRR MEDICARE