Individual
DR. MARY JO SHAW
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
700 W IRONWOOD DR, SUITE 155, COEUR D ALENE, ID 83814-2656
(208) 667-0585
(208) 667-0876
Mailing address
700 W IRONWOOD DR, SUITE 155, COEUR D ALENE, ID 83814-2656
(208) 667-0585
(208) 667-0876
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
M5325
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000010000162
REGENCE BLUE SHIELD
ID
01
—
000010000163
REGENCE BLUE SHIELD
ID
05
—
000396600
—
ID
05
—
1040476
—
WA
05
—
1316957202
—
MT
01
—
53256
BLUE CROSS OF IDAHO
ID
01
—
DF474
BLUE CROSS OF IDAHO
ID
Enumeration date
08/09/2006
Last updated
12/18/2013
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