Individual
BRIAN TERRY SHAW
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.O.,
Contact information
Practice address
9089 BASELINE RD, SUITE 100, RANCHO CUCAMONGA, CA 91730-1295
(909) 483-0505
(909) 483-0508
Mailing address
9089 BASELINE RD, SUITE 100, RANCHO CUCAMONGA, CA 91730-1295
(909) 483-0505
(909) 483-0508
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
20A10900
CA
Other
Enumeration date
09/08/2009
Last updated
09/08/2009
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