Provider Demographics
NPI:1063244986
Name:SHAW, AARON BRETT
Entity type:Individual
Prefix:
First Name:AARON
Middle Name:BRETT
Last Name:SHAW
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3835 E VIKING DR
Mailing Address - Street 2:
Mailing Address - City:EDEN
Mailing Address - State:UT
Mailing Address - Zip Code:84310-6802
Mailing Address - Country:US
Mailing Address - Phone:801-663-6671
Mailing Address - Fax:
Practice Address - Street 1:930 N SWITZER CANYON DR STE 101
Practice Address - Street 2:
Practice Address - City:FLAGSTAFF
Practice Address - State:AZ
Practice Address - Zip Code:86001-4834
Practice Address - Country:US
Practice Address - Phone:928-499-3100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-19
Last Update Date:2024-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ315677207QG0300X
UT5275148-3102251J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care
No207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine