Individual
LEON R SHAW
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
0101234439
VA
207L00000X
Anesthesiology Physician
Primary
D0065441
MD
207L00000X
Anesthesiology Physician
MD040830
DC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
005720800
—
VA
01
—
1809123-000
MEDICAID - WV
VA
01
—
289021
ANTHEM BCBS
VA
01
—
P00019895
MEDICARE - RR
VA
Enumeration date
06/19/2006
Last updated
01/22/2024
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