Provider Demographics
NPI:1780848341
Name:SHAW, LUKE PHILIP REINE (DO)
Entity Type:Individual
Prefix:DR
First Name:LUKE
Middle Name:PHILIP REINE
Last Name:SHAW
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 2580
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65801-2580
Mailing Address - Country:US
Mailing Address - Phone:417-829-4620
Mailing Address - Fax:417-829-4316
Practice Address - Street 1:2711 S MEADOWBROOK AVE
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65807-5924
Practice Address - Country:US
Practice Address - Phone:417-887-0081
Practice Address - Fax:417-227-1412
Is Sole Proprietor?:No
Enumeration Date:2008-07-14
Last Update Date:2014-10-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MO2008015988207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1780848341Medicaid
MO132680251Medicare PIN