Shaw, Jeffrey L

Shaw, Jeffrey L is an individual health care provider with primary practice located at 1821 S Webster Ave , Green Bay WI 54301. He recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Allergy & Immunology, Allopathic & Osteopathic Physicians / Pediatrics. Allopathic & Osteopathic Physicians / Allergy & Immunology is his primary health care specialty. Shaw, Jeffrey L can be contacted via phone (920) 496-4700.

Contact Information

Primary practice address
1821 S Webster Ave Green Bay WI 54301
Phone: (920) 496-4700
Fax: (920) 431-1914
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Allergy & Immunology 207K00000X 20844 West Virginia
Allopathic & Osteopathic Physicians / Allergy & Immunology 207K00000X 42113-020 Wisconsin
Allopathic & Osteopathic Physicians / Pediatrics 208000000X 20884 West Virginia

Profile Details

NPI number 1124083712
LBN Legal business name Shaw, Jeffrey L
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Apr 18th, 2006
Last updated Jan 12th, 2017 - about 7 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1124083712 NPPES
Ohio MEDICAID 2324505
Ohio MEDICAID 1840670000
Ohio MEDICAID 64049158

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