Provider Demographics
NPI:1730149550
Name:SHAW, WILLIAM E JR (MD)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:E
Last Name:SHAW
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1045 N COURTENAY PKWY
Mailing Address - Street 2:
Mailing Address - City:MERRITT ISLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32953-4531
Mailing Address - Country:US
Mailing Address - Phone:321-453-3937
Mailing Address - Fax:855-816-8467
Practice Address - Street 1:1045 N COURTENAY PKWY
Practice Address - Street 2:
Practice Address - City:MERRITT ISLAND
Practice Address - State:FL
Practice Address - Zip Code:32953-4531
Practice Address - Country:US
Practice Address - Phone:321-453-3937
Practice Address - Fax:855-816-8467
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-24
Last Update Date:2022-10-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL036085447207W00000X
FLME154015207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL114592300Medicaid
VA006304010Medicaid
VA006304010Medicaid