Provider Demographics
NPI:1285699827
Name:SHAW, ROBERT W III (MD)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:W
Last Name:SHAW
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:PO BOX 776351
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60677-6351
Mailing Address - Country:US
Mailing Address - Phone:502-588-9490
Mailing Address - Fax:502-272-5116
Practice Address - Street 1:825 BARRET AVE
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40204-1743
Practice Address - Country:US
Practice Address - Phone:502-540-7200
Practice Address - Fax:502-540-7207
Is Sole Proprietor?:No
Enumeration Date:2006-04-18
Last Update Date:2016-07-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KY20242207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY1054774OtherPASSPORT
KY008909OtherSIHO
IN100360800Medicaid
KY000000050956OtherANTHEM
KY110139027OtherRAILROAD MEDICARE
KY2538067OtherCIGNA
KY2433724000OtherPASSPORT ADVANTAGE
KY64202427Medicaid
KY000023028FOtherHUMANA
KY10806119OtherCAQH
KY110139027OtherRAILROAD MEDICARE
KYC74263Medicare UPIN