Provider Demographics
NPI:1922099555
Name:SHAW, RONALD LORIN (MD)
Entity Type:Individual
Prefix:DR
First Name:RONALD
Middle Name:LORIN
Last Name:SHAW
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10051 5TH ST N STE 200
Mailing Address - Street 2:
Mailing Address - City:SAINT PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33702-2211
Mailing Address - Country:US
Mailing Address - Phone:727-824-0780
Mailing Address - Fax:727-568-6011
Practice Address - Street 1:2304 ALOMA AVE
Practice Address - Street 2:
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32792-3330
Practice Address - Country:US
Practice Address - Phone:407-679-9222
Practice Address - Fax:407-679-9061
Is Sole Proprietor?:No
Enumeration Date:2005-11-02
Last Update Date:2020-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0044966207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLC13264OtherRAILROAD GROUP NUMBER
FL069347200Medicaid
FL220003327OtherRAILROAD MEDICARE
FL593339550OtherWINTER PARK FAMILY HEALTH CENTER, INC
FL069347200Medicaid
FL593339550OtherWINTER PARK FAMILY HEALTH CENTER, INC
FL47663ZMedicare PIN
FL593339550OtherWINTER PARK FAMILY HEALTH CENTER, INC
FL47663ZMedicare PIN