Provider Demographics
NPI:1871991000
Name:TRAVIS SHAW MD PC
Entity type:Organization
Organization Name:TRAVIS SHAW MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TRAVIS
Authorized Official - Middle Name:LARON
Authorized Official - Last Name:SHAW
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:804-775-4559
Mailing Address - Street 1:8730 STONY POINT PKWY
Mailing Address - Street 2:STE 120
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23235-1970
Mailing Address - Country:US
Mailing Address - Phone:804-775-4559
Mailing Address - Fax:804-212-2476
Practice Address - Street 1:8730 STONY POINT PARKWAY
Practice Address - Street 2:STE 120
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23235
Practice Address - Country:US
Practice Address - Phone:804-775-4559
Practice Address - Fax:804-212-2476
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-22
Last Update Date:2014-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101245920261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service