Individual
DR. SUSAN L GIN-SHAW
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
19829 N 27TH AVE, PHOENIX, AZ 85027-4001
(623) 879-5445
Mailing address
1632 N 9TH AVE, PHOENIX, AZ 85007-1708
(602) 689-0638
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
17053
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
293358
—
AZ
01
—
86080015085259A283
TRIWEST
AZ
01
—
P00266840
RAILROAD MEDICARE
AZ
Enumeration date
12/09/2005
Last updated
05/07/2020
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