Organization
TIMOTHY SHANE SHAW MD, PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. TIMOTHY SHANE SHAW M.D. (ORTHOPAEDIC SURGEON)
(936) 328-8080
Entity
Organization
Contact information
Practice address
210 WEST PARK DR., STE 100, LIVINGSTON, TX 77351-9226
(936) 328-8080
(936) 328-8505
Mailing address
210 WEST PARK DR., STE 100, LIVINGSTON, TX 77351-9226
(936) 328-8080
(936) 328-8505
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
M1343
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0079QS
BLUE CROSS BLUE SHIELD TEXAS
TX
01
—
1316930183
NPI TYPE 1
TX
05
—
176109001
—
TX
01
—
DD8565
MEDICARE RAILROAD
TX
Enumeration date
03/28/2007
Last updated
03/30/2010
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