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Individual

DR. KENNETH NEIL SHAW

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
M.D.

Contact information

Practice address
709 MIDDLE CREEK RD, SEVIERVILLE, TN 37862-5047
(865) 453-7111
Mailing address
PO BOX 634706, CINCINNATI, OH 45263-0001

Taxonomy

Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
MD021361
TN

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
0154929
BLUE CROSS
TN
01
3081457
BLUE CROSS
TN
05
3816910
TN
05
3816911
TN
05
64035975
KY
01
P00211373
RAILROAD MEDICARE
TN
01
P00312153
RAILROAD MEDICARE
TN
Enumeration date
06/12/2006
Last updated
11/29/2007
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