Shaw, Mary Jo

Shaw, Mary Jo is an individual health care provider with primary practice located at 700 W Ironwood Dr Suite 155, Coeur D Alene ID 83814-2656. She recently has only one registered license in Allopathic & Osteopathic Physicians / Pediatrics, which is considered as her primary health care specialty. Shaw, Mary Jo can be contacted via phone (208) 667-0585.

Contact Information

Primary practice address
700 W Ironwood Dr Suite 155 Coeur D Alene ID 83814-2656
Phone: (208) 667-0585
Fax: (208) 667-0876
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Pediatrics 208000000X M5325 Idaho

Profile Details

NPI number 1316957202
LBN Legal business name Shaw, Mary Jo
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Aug 9th, 2006
Last updated Dec 18th, 2013 - about 13 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 1316957202 NPPES
Idaho Other 000010000163 REGENCE BLUE SHIELD
Idaho MEDICAID 1040476 REGENCE BLUE SHIELD
Idaho Other 000010000162 REGENCE BLUE SHIELD
Idaho MEDICAID 1316957202 REGENCE BLUE SHIELD
Idaho Other DF474 REGENCE BLUE SHIELD
Idaho MEDICAID 000396600 REGENCE BLUE SHIELD
Idaho Other 53256 REGENCE BLUE SHIELD

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