Doctor Name: | TIMOTHY SHANE SHAW |
NPI Number: | 1316930183 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | M.D., P.A. |
License Number: | M1343 |
Business Practice Address: | 601 Ogeltree Dr. Suite D Livingston, TX - 77351 |
Business Phone Number: | 9363288080 |
Business Fax Number: | 9363288505 |
Mailing Address: | 601 Ogletree Dr, Suite D LIVINGSTON |
State: | TX |
Postal Code: | 773519226 |
Phone Number: | 9363288080 |
Fax Number: | 9363288505 |
NPI Enumeration Date: | 08/26/2005 |
NPI Last Update Date: | 10/12/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 174400000X |
License Number: | M1343 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | TX |
Taxonomy Type: | Other Service Providers |
Taxonomy Classification: | Specialist |
Taxonomy Specialization: | |
Taxonomy Definition: | An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. |