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ERIC GORGON SHAW

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
M.D.

Contact information

Practice address
4900 BROAD RD, SYRACUSE, NY 13215-2265
(315) 492-5535
(315) 492-8690
Mailing address
20830 CAGWIN RD, WATERTOWN, NY 13601-5364
(315) 583-5304

Taxonomy

Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
224829
NY

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
02650246
NY
01
P00869153
RAILROAD MEDICARE
NY
Enumeration date
03/28/2006
Last updated
08/14/2013
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