Provider Demographics
NPI:1710067988
Name:SHAW, ENOCH D (MD)
Entity Type:Individual
Prefix:
First Name:ENOCH
Middle Name:D
Last Name:SHAW
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:E
Other - Middle Name:DAVID
Other - Last Name:SHAW
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:2720 COMMERCIAL ST SE
Mailing Address - Street 2:STE 201
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97302-4495
Mailing Address - Country:US
Mailing Address - Phone:503-480-0485
Mailing Address - Fax:503-480-0486
Practice Address - Street 1:2720 COMMERCIAL ST SE
Practice Address - Street 2:STE 201
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97302-4495
Practice Address - Country:US
Practice Address - Phone:503-480-0485
Practice Address - Fax:503-480-0486
Is Sole Proprietor?:No
Enumeration Date:2006-10-16
Last Update Date:2014-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD08663207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR004887Medicaid
C93756Medicare UPIN
BHJFNMedicare ID - Type Unspecified