Provider Demographics
NPI:1972579589
Name:SHAW, ERIN JACKS (MD)
Entity Type:Individual
Prefix:
First Name:ERIN
Middle Name:JACKS
Last Name:SHAW
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:10470 OLD PLACERVILLE RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95827-2539
Mailing Address - Country:US
Mailing Address - Phone:855-771-0335
Mailing Address - Fax:
Practice Address - Street 1:685 TWELVE BRIDGES DR
Practice Address - Street 2:SUITE B
Practice Address - City:LINCOLN
Practice Address - State:CA
Practice Address - Zip Code:95648-8689
Practice Address - Country:US
Practice Address - Phone:916-408-5915
Practice Address - Fax:916-408-5406
Is Sole Proprietor?:No
Enumeration Date:2006-02-23
Last Update Date:2015-07-10
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAA87558208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics