Individual
TIMOTHY SHANE SHAW
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D., P.A.
Contact information
Practice address
601 OGELTREE DR., SUITE D, LIVINGSTON, TX 77351
(936) 328-8080
(936) 328-8505
Mailing address
601 OGLETREE DR, SUITE D, LIVINGSTON, TX 77351-9226
(936) 328-8080
(936) 328-8505
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
M1343
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1788538
—
LA
01
—
P00256091
MEDICARE RAILROAD
TX
Enumeration date
08/26/2005
Last updated
10/12/2007
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