Individual
GARY H SHAW
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Taxonomy
Speciality
Code
Description
License number
State
207RN0300X
Nephrology Physician
Primary
4301045389
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1013921154
—
MI
01
—
GS045389
BS STATE LIC#
MI
Enumeration date
07/27/2006
Last updated
09/25/2020
Update your record
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