Individual
JOHN C SHAW
Active
Individual
JOHN C SHAW
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
01035377A
IN
207X00000X
Orthopaedic Surgery Physician
Primary
24102
KY
208100000X
Physical Medicine & Rehabilitation Physician
01035377A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000048660
ANTHEM
KY
05
—
100359260
—
IN
01
—
1050654
PASSPORT
KY
01
—
2432935000
PASSPORT ADVANTAGE
KY
01
—
250002297
KY RAILROAD MEDICARE
KY
01
—
61-1086535
TAX ID
KY
05
—
64241029
—
KY
01
—
P00003389
IND RAILROAD MEDICARE
IN
Enumeration date
02/14/2006
Last updated
01/11/2019
Update your record
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