Individual
PETER JOSEPH SHAW
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
7950 W JEFFERSON BLVD, FORT WAYNE, IN 46804-4160
(260) 435-7001
Mailing address
7950 W JEFFERSON BLVD, FORT WAYNE, IN 46804-4160
(260) 435-7001
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
01087769A
IN
207P00000X
Emergency Medicine Physician
4351044601
MI
390200000X
Student in an Organized Health Care Education/Training Program
—
MI
Other
Enumeration date
04/01/2019
Last updated
01/08/2024
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