Individual
GARY THOMAS SHAW
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
121 SOTOYOME ST, SANTA ROSA, CA 95405-4823
(707) 546-4062
(707) 525-4097
Mailing address
PO BOX 5651, ORANGE, CA 92863-5651
(714) 571-5000
(714) 571-5055
Taxonomy
Speciality
Code
Description
License number
State
2085B0100X
Body Imaging Physician
G54948
CA
2085N0904X
Nuclear Radiology Physician
G54948
CA
2085R0202X
Diagnostic Radiology Physician
G54948
CA
2085R0204X
Vascular & Interventional Radiology Physician
Primary
G54948
CA
2085U0001X
Diagnostic Ultrasound Physician
G54948
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00G549480
—
CA
Enumeration date
10/16/2006
Last updated
06/10/2014
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