Provider Demographics
NPI:1215964994
Name:SHAW, STEPHEN R (MD)
Entity type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:R
Last Name:SHAW
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Gender:M
Credentials:MD
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Mailing Address - Street 1:3418 LOMA VISTA RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93003-3016
Mailing Address - Country:US
Mailing Address - Phone:805-642-0128
Mailing Address - Fax:805-656-3421
Practice Address - Street 1:3418 LOMA VISTA RD
Practice Address - Street 2:SUITE B
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93003-3016
Practice Address - Country:US
Practice Address - Phone:805-642-0128
Practice Address - Fax:805-656-3421
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2007-07-08
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Provider Licenses
StateLicense IDTaxonomies
CAG47926207XS0117X, 208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the Spine
Not Answered208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA50864Medicare UPIN