Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207XS0117X | Orthopaedic Spine Surgeon | G47926 | CA |
NPI | 1215964994 |
---|---|
Provider Name | Dr. Stephen R. Shaw |
First Address | Ventura, CA 93003-3016 |
Second Address | Ventura, CA 93003-3016 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/06/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
A50864 | (02) | CA |