Doctor Name: | DR. ISAAC BERNARD SHAW |
NPI Number: | 1669552600 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | M.D. |
License Number: | 35.051823 |
Business Practice Address: | 3601 Sw 160th Ave Suite 250 Miramar, FL - 330276308 |
Business Phone Number: | 8778667123 |
Business Fax Number: | |
Mailing Address: | 12000 Stone Lake Rd, DULCE |
State: | NM |
Postal Code: | 875280187 |
Phone Number: | 5757593291 |
Fax Number: | 5757597243 |
NPI Enumeration Date: | 10/16/2006 |
NPI Last Update Date: | 10/13/2011 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 208D00000X |
License Number: | 35.051823 |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | OH |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | General Practice |
Taxonomy Specialization: | |
Taxonomy Definition: |