Provider Demographics
NPI:1912989872
Name:SHAW, ROBERT H (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:H
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 1:5252 N HIGHWAY 171
Mailing Address - Street 2:
Mailing Address - City:CLEBURNE
Mailing Address - State:TX
Mailing Address - Zip Code:76033-8064
Mailing Address - Country:US
Mailing Address - Phone:817-296-0375
Mailing Address - Fax:817-558-7529
Practice Address - Street 1:5252 N HIGHWAY 171
Practice Address - Street 2:
Practice Address - City:CLEBURNE
Practice Address - State:TX
Practice Address - Zip Code:76033-8064
Practice Address - Country:US
Practice Address - Phone:817-296-0375
Practice Address - Fax:817-558-7529
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-16
Last Update Date:2017-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXD8816207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
013539461OtherMEDICARE RAILROAD
TX013539461Medicaid
TX201169401Medicaid
8H0010OtherBLUE SHIELD
0011037OtherUNITEDHEALTHCARE
000130901OtherAETNA
TX201169401Medicaid
TX013539461Medicaid
TX8F9641Medicare PIN