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Organization

SHAW PEDIATRICS PA

Active
Organization subpart
No

Provider details

NPI number
Authorized official
DR. CLYDE EDWARD SHAW M.D. (PRESIDENT)
(903) 957-7429
Entity
Organization

Contact information

Practice address
240 E EVERGREEN ST, SHERMAN, TX 75090-5056
(903) 957-7429
(903) 957-7424
Mailing address
240 E EVERGREEN ST, SHERMAN, TX 75090-5056
(903) 957-7429

Taxonomy

Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
Primary
E2856
TX

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
100155410A
OK
05
129563606
TX
Enumeration date
11/05/2013
Last updated
11/05/2013
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