Basic Information
| Provider Information | |||||||||
| NPI: | 1457443079 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SHAW | ||||||||
| FirstName: | JAMES | ||||||||
| MiddleName: | ROBERT | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 602373 | ||||||||
| Address2: | CHARLOTTE | ||||||||
| City: | CHARLOTTE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 282602373 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8282131500 | ||||||||
| FaxNumber: | 8286516570 | ||||||||
| Practice Location | |||||||||
| Address1: | 377 GALLIMORE RD | ||||||||
| Address2: | BREVARD | ||||||||
| City: | BREVARD | ||||||||
| State: | NC | ||||||||
| PostalCode: | 287128874 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8288849030 | ||||||||
| FaxNumber: | 8288843563 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/29/2006 | ||||||||
| LastUpdateDate: | 02/09/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 35197 | NC | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 213592C | 01 | NC | MEDICARE PTAN | OTHER | 8975523 | 05 | NC | MEDICAID | 0637660001 | 01 | NC | PALMETTO GOVERNMENT SERVI | OTHER | 561852981F | 01 | NC | CIGNA | OTHER | NCM996C | 01 | NC | MEDICARE PTAN | OTHER | 01-70577 | 01 | NC | UNITED HEALTHCARE | OTHER | 080084314 | 01 | NC | RAILROAD MEDICARE | OTHER | NCM996B | 01 | NC | MEDICARE PTAN | OTHER | 75523 | 01 | NC | BLUE CROSS BLUE SHIELD | OTHER | NCM996A | 01 | NC | MEDICARE PTAN | OTHER |