Provider Demographics
NPI:1205114816
Name:SHAW, CHRISTIAN (MD, PHD)
Entity type:Individual
Prefix:
First Name:CHRISTIAN
Middle Name:
Last Name:SHAW
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3014 E CAMELBACK RD STE 741
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85016-4404
Mailing Address - Country:US
Mailing Address - Phone:480-455-0462
Mailing Address - Fax:
Practice Address - Street 1:3014 E CAMELBACK RD STE 741
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85016-4404
Practice Address - Country:US
Practice Address - Phone:480-455-0462
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-31
Last Update Date:2023-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMMD201308582083A0300X
AZ492322083X0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational Medicine
No2083A0300XAllopathic & Osteopathic PhysiciansPreventive MedicineAddiction Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM12653055Medicaid