Individual
JOHN C SHAW
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
220 ABRAHAM FLEXNER WAY, SUITE 1100, LOUISVILLE, KY 40202-3826
(502) 584-3377
(502) 584-1385
Mailing address
PO BOX 909, LOUISVILLE, KY 40201-0909
(502) 584-3377
(502) 584-1385
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
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