Provider Demographics
NPI:1396768107
Name:SHAW, JEFFREY B (MD)
Entity type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:B
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 1:597 BANBURY RD
Mailing Address - Street 2:
Mailing Address - City:CENTERVILLE FINANCE
Mailing Address - State:OH
Mailing Address - Zip Code:45459-1645
Mailing Address - Country:US
Mailing Address - Phone:937-435-6876
Mailing Address - Fax:
Practice Address - Street 1:935 STATE ROUTE 28
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:OH
Practice Address - Zip Code:45150-1911
Practice Address - Country:US
Practice Address - Phone:513-831-5955
Practice Address - Fax:513-831-5985
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2014-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35053848S207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHSH0864582Medicare PIN
OHSH0864585Medicare PIN
OHSH0864586Medicare PIN
OHSH0864581Medicare PIN
OHA17362Medicare UPIN
OHSH0864588Medicare PIN
OHSH0864584Medicare PIN
OHSH0864583Medicare PIN