Individual
VINCENT LEE SHAW JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
3604 NICHOLSON DR STE 3, BATON ROUGE, LA 70802-8602
(225) 765-5500
(225) 374-9104
Mailing address
8490 PICARDY AVE, BLDG 200, BATON ROUGE, LA 70809-3731
(225) 237-1754
(225) 237-1722
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
026422
LA
207QS0010X
Sports Medicine (Family Medicine) Physician
026422
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
026422
LA STATE LICENSE #
LA
05
—
1058823
—
LA
01
—
4J728YJGU
MEDICARE PTAN
LA
Enumeration date
07/12/2006
Last updated
09/09/2025
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