Individual
DR. J ELAINE SHAW
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1505 STATE HIGHWAY 19 S, ATHENS, TX 75751-8950
(903) 675-1725
(903) 675-7668
Mailing address
PO BOX 5500, TYLER, TX 75712-5500
(903) 324-6450
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
G3781
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
121323301
—
TX
01
—
121323304
THSTEPS-MEDICAID
TX
Enumeration date
02/21/2006
Last updated
05/13/2014
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