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Individual
DR. GRADY C SHAW
Active
Individual
DR. GRADY C SHAW
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
F7158
TX
207Q00000X
Family Medicine Physician
Primary
F7158
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00Y226
MEDICARE GROUP
TX
05
—
125737006
—
TX
01
—
DG9311
RAILROAD MEDICARE GROUP
TX
01
—
P00463100
RAILROAD MEDICARE
TX
Enumeration date
02/21/2006
Last updated
11/10/2016
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