Individual
GARRET T SHAW
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
918 20TH ST, GOTHENBURG, NE 69138-1237
(308) 537-4066
(308) 537-3074
Mailing address
918 20TH ST, GOTHENBURG, NE 69138-1237
(308) 537-4066
(308) 537-3074
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
21126
NE
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
10025024000
MEDICAID RHC
NE
05
—
470426208
—
NE
Enumeration date
02/10/2006
Last updated
09/16/2016
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