Provider Demographics
NPI:1710928205
Name:SHAW, JAMES BURR (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:BURR
Last Name:SHAW
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:7040 AVENIDA ENCINAS
Mailing Address - Street 2:#104-248
Mailing Address - City:CARLSBAD
Mailing Address - State:CA
Mailing Address - Zip Code:92011-4652
Mailing Address - Country:US
Mailing Address - Phone:760-632-7246
Mailing Address - Fax:760-942-8878
Practice Address - Street 1:1680 S MELROSE DR
Practice Address - Street 2:SUITE 105
Practice Address - City:VISTA
Practice Address - State:CA
Practice Address - Zip Code:92081-5472
Practice Address - Country:US
Practice Address - Phone:760-632-7246
Practice Address - Fax:760-942-8878
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-08
Last Update Date:2023-03-07
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Provider Licenses
StateLicense IDTaxonomies
CAA45657208VP0000X, 207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA-45657OtherSTATE LICENSE
CA103340OtherQME
CAP00712842OtherMEDICARE RAILROAD
CA614888500OtherWORK COMP DOL
CA614888500OtherWORK COMP DOL
CABS1825009OtherDEA