Provider Demographics
NPI:1073545877
Name:SHAW, BRANDON J (DO)
Entity type:Individual
Prefix:DR
First Name:BRANDON
Middle Name:J
Last Name:SHAW
Suffix:
Gender:
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:322 W BERRIDGE LN
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85013-1547
Mailing Address - Country:US
Mailing Address - Phone:602-300-9699
Mailing Address - Fax:
Practice Address - Street 1:322 W BERRIDGE LN
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85013-1547
Practice Address - Country:US
Practice Address - Phone:602-300-9699
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2025-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA23217207L00000X
TXL4710207L00000X
AZ4067207L00000X, 207LP2900X
IDO2026207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ81138Medicare PIN
I07258Medicare UPIN
AZP00345025Medicare PIN