Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207QA0505X | Family Doctor - Adult Medicine | F1998 | TX |
Y | 207QG0300X | Family Doctor - Geriatric Medicine | F1998 | TX |
NPI | 1346203007 |
---|---|
Provider Name | Milton D Shaw |
First Address | Boerne, TX 78006-5683 |
Second Address | Boerne, TX 78006-5683 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/04/2006 |
Last Update Date | 12/03/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
8FJ269 | BCBS (01) | TX |