Gary H Shaw, M.D.

Primary specialty

Nephrology PhysicianTaxonomy code 207RN0300X

License

4301045389 Issued in MI

Practice address

416 Connable Ave
Petoskey, MI 49770-2212

Phone

(231) 487-7303

Fax

(231) 487-7313

NPI assigned

Jul 27, 2006

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Interoperability endpoints

• Direct secure messaging: garyshaw@stclairspe.allscriptsdirect.net

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1153958400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1600992000000",
    "number": "1013921154",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "560 W MITCHELL ST",
            "address_2": "STE 160",
            "city": "PETOSKEY",
            "state": "MI",
            "postal_code": "497702276",
            "telephone_number": "231-487-3295",
            "fax_number": "231-487-5069"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "416 CONNABLE AVE",
            "city": "PETOSKEY",
            "state": "MI",
            "postal_code": "497702212",
            "telephone_number": "231-487-7303",
            "fax_number": "231-487-7313"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHAW",
        "first_name": "GARY",
        "middle_name": "H",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-07-27",
        "last_updated": "2020-09-25",
        "certification_date": "2020-09-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RN0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Nephrology",
            "state": "MI",
            "license": "4301045389",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BS STATE LIC#",
            "identifier": "GS045389",
            "state": "MI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1013921154",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Sernity Home Care
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• Laurie A Severn, LPTA
• Anton A. Sharapov, M.D.
• Marcia Shattuck, MD
• Robert Scott Sheperd, DDS
• Todd M Sheperd, MD
• Adrienne Josephine Shiels, LLMSW
• James M Shirilla, MD
• Melinda Yvette Short, AGACNP-BC, BSN, RN

• Nephrology Physician in Petoskey, MI
• Providers in Petoskey, MI by specialty
• Nephrology Physician in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 25, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.