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Individual

GREGORY EDWARD SHAW

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man

Contact information

Practice address
100 MALLARD CREEK RD STE 395, LOUISVILLE, KY 40207-5167
(502) 895-9421
(502) 899-5762
Mailing address
PO BOX 776879, CHICAGO, IL 60677-6879
(502) 588-9490
(502) 272-5116

Taxonomy

Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
50503
KY

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
300011149
IN
05
7100488410
KY
01
K246121
MEDICARE
KY
Enumeration date
03/27/2014
Last updated
09/21/2022
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