Provider Demographics
NPI:1629085477
Name:SHAW, MAURICE H (MD)
Entity Type:Individual
Prefix:
First Name:MAURICE
Middle Name:H
Last Name:SHAW
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4033 TAMPA RD
Mailing Address - Street 2:STE. 101
Mailing Address - City:OLDSMAR
Mailing Address - State:FL
Mailing Address - Zip Code:34677-3224
Mailing Address - Country:US
Mailing Address - Phone:813-854-2003
Mailing Address - Fax:813-855-2367
Practice Address - Street 1:4446 E FLETCHER AVE
Practice Address - Street 2:SUITE A
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33613
Practice Address - Country:US
Practice Address - Phone:813-971-6700
Practice Address - Fax:813-977-1352
Is Sole Proprietor?:No
Enumeration Date:2006-08-02
Last Update Date:2013-12-03
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLME17432208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL035899100Medicaid
D53654Medicare UPIN