Provider Demographics
NPI:1881760882
Name:SHAW, GERALD P (MD)
Entity type:Individual
Prefix:DR
First Name:GERALD
Middle Name:P
Last Name:SHAW
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:8004 W DONALD DR
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85383-2114
Mailing Address - Country:US
Mailing Address - Phone:602-405-5627
Mailing Address - Fax:623-486-3747
Practice Address - Street 1:18301 N 79TH AVE
Practice Address - Street 2:STE C126
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85308-8463
Practice Address - Country:US
Practice Address - Phone:623-486-3346
Practice Address - Fax:623-486-3747
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-28
Last Update Date:2009-02-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZ103422084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZAZ0871340OtherBCBS OF AZ
AZ260282Medicaid
AZ67089Medicare ID - Type Unspecified
AZD37638Medicare UPIN