Provider Demographics
NPI:1629279047
Name:SHAW, TRAVIS LARON (MD)
Entity Type:Individual
Prefix:
First Name:TRAVIS
Middle Name:LARON
Last Name:SHAW
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:8730 STONY POINT PKWY
Mailing Address - Street 2:SUITE 120
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23235-1970
Mailing Address - Country:US
Mailing Address - Phone:804-775-4559
Mailing Address - Fax:804-200-5649
Practice Address - Street 1:8730 STONY POINT PKWY
Practice Address - Street 2:SUITE 120
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23235-1970
Practice Address - Country:US
Practice Address - Phone:804-775-4559
Practice Address - Fax:804-200-5649
Is Sole Proprietor?:No
Enumeration Date:2007-05-31
Last Update Date:2013-01-29
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Provider Licenses
StateLicense IDTaxonomies
VA0101245920207YX0007X, 2082S0099X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2082S0099XAllopathic & Osteopathic PhysiciansPlastic SurgeryPlastic Surgery Within the Head and Neck
No207YX0007XAllopathic & Osteopathic PhysiciansOtolaryngologyPlastic Surgery within the Head & Neck