Provider Demographics
NPI:1801993951
Name:SHAW, ANGELA C (DO)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:C
Last Name:SHAW
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 MT CARMEL WAY
Mailing Address - Street 2:
Mailing Address - City:PITTSBURG
Mailing Address - State:KS
Mailing Address - Zip Code:66762-7587
Mailing Address - Country:US
Mailing Address - Phone:620-230-0044
Mailing Address - Fax:620-230-0543
Practice Address - Street 1:1300 E CENTENNIAL DR
Practice Address - Street 2:
Practice Address - City:PITTSBURG
Practice Address - State:KS
Practice Address - Zip Code:66762-6650
Practice Address - Country:US
Practice Address - Phone:620-230-0044
Practice Address - Fax:620-230-0543
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2020-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS0530788207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS200267370AMedicaid
OK200052810AMedicaid
KS200267370AMedicaid