Provider Demographics
NPI:1245300391
Name:SHAW, JOHN T (MD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:T
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 1:1916 PATTERSON ST
Mailing Address - Street 2:SUITE 300
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37203-2120
Mailing Address - Country:US
Mailing Address - Phone:615-327-1737
Mailing Address - Fax:
Practice Address - Street 1:1916 PATTERSON ST
Practice Address - Street 2:SUITE 300
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37203-2120
Practice Address - Country:US
Practice Address - Phone:615-327-1737
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-08
Last Update Date:2019-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD0000025916207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3373619Medicaid
TN30872001Medicaid
TN30872001Medicare PIN
TN3087209Medicare PIN
F43191Medicare UPIN
TN3087209Medicare ID - Type UnspecifiedINDIVIDUAL