Provider Demographics
NPI:1649515297
Name:SHAW, KATHRYN WEBER (MD)
Entity type:Individual
Prefix:DR
First Name:KATHRYN
Middle Name:WEBER
Last Name:SHAW
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:2900 CORPORATE WAY
Mailing Address - Street 2:DOOR D
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33025-3925
Mailing Address - Country:US
Mailing Address - Phone:954-276-5685
Mailing Address - Fax:954-985-7074
Practice Address - Street 1:1150 N 35TH AVE STE 390
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33021-5429
Practice Address - Country:US
Practice Address - Phone:954-265-7450
Practice Address - Fax:954-265-7459
Is Sole Proprietor?:No
Enumeration Date:2012-12-09
Last Update Date:2021-03-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WAMD60740019208600000X
FLME141862208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery