Individual
JEFFREY L SHAW
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1821 S WEBSTER AVE, GREEN BAY, WI 54301
(920) 496-4700
(920) 431-1914
Mailing address
PO BOX 19070, GREEN BAY, WI 54307-9070
(920) 496-4700
Taxonomy
Speciality
Code
Description
License number
State
207K00000X
Allergy & Immunology Physician
20844
WV
207K00000X
Allergy & Immunology Physician
Primary
42113-020
WI
208000000X
Pediatrics Physician
20884
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1840670000
—
WV
05
—
2324505
—
OH
05
—
64049158
—
KY
Enumeration date
04/18/2006
Last updated
01/12/2017
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