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Individual

DR. ERVIN BART SHAW

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
M.D.

Contact information

Practice address
2720 SUNSET BLVD, WEST COLUMBIA, SC 29169-4810
(803) 936-8146
(803) 936-8916
Mailing address
PO BOX 2375, WEST COLUMBIA, SC 29171-2375
(803) 936-8146
(803) 936-8916

Taxonomy

Speciality
Code
Description
License number
State
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
Primary
6123
SC

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
061239
SC
Enumeration date
04/06/2006
Last updated
03/03/2016
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