Individual
DR. TAVIS M. SHAW
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
4881 SUGAR MAPLE DR, WPAFB, OH 45433-5529
(937) 257-9292
Mailing address
4881 SUGAR MAPLE DR., WRIGHT PATTERSON MEDICAL CENTER, WPAFB, OH 45433
(937) 257-9292
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
OS013233
PA
208800000X
Urology Physician
Primary
34.009996
OH
208800000X
Urology Physician
OS013233
PA
Other
Enumeration date
11/06/2006
Last updated
03/20/2015
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