GARY THOMAS SHAW (NPI# 1568542306) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1568542306 |
| Entity Type | Individual |
| Full Name | GARY THOMAS SHAW |
| Credential | M.D. |
| Practice Address |
121 Sotoyome St Santa Rosa CA 95405-4823 |
| Mailing Address |
Po Box 5651 Orange CA 92863-5651 |
| Practice Telephone | 7075464062 |
| Practice Fax Number | 7075254097 |
| Mailing Telephone | 7145715000 |
| Mailing Fax Number | 7145715055 |
| Enumeration Date | 2006-10-16 |
| Last Update Date | 2014-06-10 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 2085B0100X |
Radiology Specialization: Body Imaging |
G54948 | CA | Allopathic & Osteopathic Physicians |
| N | 2085N0904X |
Radiology Specialization: Nuclear Radiology |
G54948 | CA | Allopathic & Osteopathic Physicians |
| N | 2085R0202X |
Radiology Specialization: Diagnostic Radiology |
G54948 | CA | Allopathic & Osteopathic Physicians |
| Y | 2085R0204X |
Radiology Specialization: Vascular & Interventional Radiology |
G54948 | CA | Allopathic & Osteopathic Physicians |
| N | 2085U0001X |
Radiology Specialization: Diagnostic Ultrasound |
G54948 | CA | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| CA | 00G549480 | 05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1669667911 | Gary Marshall Shaw | Social Worker | 1511 W Saint Johns Ave, Austin, TX 78757-1819 | 2007-09-10 |
| 1477689529 | Gary Shaw | Physical Therapist | 3218 18th St Nw, Washington, DC 20010-1002 | 2007-02-25 |
| 1215026612 | Gary Graham Shaw | Dentist | 435 W 600 N, Tremonton, UT 84337-2411 | 2006-10-12 |
| 1245576420 | Gary Shaw | Counselor | 359 Fenn St, Administrative Offices, Pittsfield, MA 01201-5261 | 2012-12-17 |
| 1154587087 | Gary R Shaw | Dentist | 4103 Bridgeport Way W, Ste A, University Place, WA 98466-4300 | 2008-07-30 |
| 1013921154 | Gary H Shaw | Internal Medicine | 416 Connable Ave, Petoskey, MI 49770-2212 | 2006-07-27 |
| 1912940958 | Gary Y. Shaw | Otolaryngology | 180 S Main St, Canton, IL 61520-2608 | 2006-06-14 |
| Street Address |
121 SOTOYOME ST |
| City | SANTA ROSA |
| State | CA |
| Zip Code | 95405-4823 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1023089729 | Marlene Patricia Lennon | Nurse Practitioner | 121 Sotoyome St, Santa Rosa, CA 95405-4823 | 2006-01-30 |
| 1821417296 | Nicholas Mcgarvey | Radiology | 121 Sotoyome St, Santa Rosa, CA 95405-4823 | 2014-04-14 |
| 1326461708 | Redwood Radiology Group Inc | Radiology | 121 Sotoyome St, Santa Rosa, CA 95405-4823 | 2014-01-21 |
| 1225471337 | Alexander Page | Radiology | 121 Sotoyome St, Santa Rosa, CA 95405-4823 | 2013-04-09 |
| 1275819641 | Kathleen A Mott | Nurse Practitioner | 121 Sotoyome St, Santa Rosa, CA 95405-4823 | 2011-10-28 |
| 1720373376 | Anusuya Mokashi | Radiology | 121 Sotoyome St, Santa Rosa, CA 95405-4823 | 2011-06-12 |
| 1558651091 | Vivek G. Sahani | Radiology | 121 Sotoyome St, Santa Rosa, CA 95405-4823 | 2011-04-18 |
| 1043531643 | Gary Raymond Roper | Radiology | 121 Sotoyome St, Santa Rosa, CA 95405-4823 | 2010-06-17 |
| 1316176712 | Lesley M Field | Physician Assistant | 121 Sotoyome St, Santa Rosa, CA 95405-4823 | 2009-07-07 |
| 1578797601 | Raymond F. Conway IIi | Radiology | 121 Sotoyome St, Santa Rosa, CA 95405-4823 | 2009-05-04 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1083230486 | Lizett Camacho | Counselor | 145o Neotomas Avenue Suite 200, Santa Rosa, CA 95405 | 2020-06-22 |
| 1346768918 | Ingrid Tsong | Student in an Organized Health Care Education/Training Program | 3447 Summerfield Road, Santa Rosa, CA 95405 | 2017-09-05 |
| 1275051898 | Jessica Peters Malmberg | Student in an Organized Health Care Education/Training Program | 2447 Summerfield Rd, Santa Rosa, CA 95405 | 2017-09-04 |
| 1306246772 | Kirsten Eckert | Advanced Practice Midwife | 500 Doyle Park Dr Suite 103, Santa Rosa, CA 95405 | 2014-09-03 |
| 1982034294 | Mohammad Reza Saeidi | Dentist | 1820 Sonoma Ave Ste 90a, Santa Rosa, CA 95405 | 2013-11-22 |
| 1851631642 | Debi M. Emmons | Marriage & Family Therapist | 2447 Summerfield Dr, Social Advocates for Youth, Santa Rosa, CA 95405 | 2013-02-15 |
| 1841549979 | Karie Louise Klim | Marriage & Family Therapist | 182 Farmers Ln Ste 204, Santa Rosa, CA 95405 | 2012-09-05 |
| 1427314400 | Rachel E. Page | Counselor | 2447 Summerfield Rd., Santa Rosa, CA 95405 | 2012-04-04 |
| 1689991572 | Center for Integral Healing Inc. | Community Health Worker | 182 Farmers Lane, #203, Santa Rosa, CA 95405 | 2010-04-30 |
| 1588997647 | Kai Morgan | Dentist | 1144 Suite 116 Soonoma Ave, Santa Rosa, CA 95405 | 2009-09-08 |
| Find all providers in zip 95405 | ||||
| Taxonomy Code | 2085R0204X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Radiology |
| Specialization | Vascular & Interventional Radiology |
| A radiologist who diagnoses and treats diseases by various radiologic imaging modalities. These include fluoroscopy, digital radiography, computed tomography, sonography and magnetic resonance imaging. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added] Additional Resources: American Board of Radiology, 2007. http://www.theabr.org/. Board certification for Medical Doctors (MDs) is provided by the American Board of Radiology. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1225471337 | Alexander Page | Radiology | 121 Sotoyome St, Santa Rosa, CA 95405-4823 | 2013-04-09 |
| 1558651091 | Vivek G. Sahani | Radiology | 121 Sotoyome St, Santa Rosa, CA 95405-4823 | 2011-04-18 |
| 1578797601 | Raymond F. Conway IIi | Radiology | 121 Sotoyome St, Santa Rosa, CA 95405-4823 | 2009-05-04 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1134739949 | Ava Vascular | Radiology | 1281 W. C. Street, Suite 200, Colton, CA 92324 | 2020-08-06 |
| 1306467204 | Saleh Radiology of Inland Empire | Radiology | 15276 Ledgestone St, Fontana, CA 92336-4048 | 2020-05-01 |
| 1366084535 | Luo Xu | Radiology | 757 Westwood Plz # 2146, Los Angeles, CA 90095-8358 | 2019-10-09 |
| 1346717824 | Cvs Medical Group, Inc | Radiology | 201 W Garvey Ave Ste 102-502, Monterey Park, CA 91754-7418 | 2018-11-01 |
| 1407353675 | Art Vascular & Interventional Associates Inc | Radiology | 324 S Beverly Dr Ste 345, Beverly Hills, CA 90212-4801 | 2018-04-12 |
| 1568971869 | Broad Reach Specialty Surgery Inc | Radiology | 8117 West Manchester Ave, Ste 368, Playa Del Rey, CA 90293 | 2017-09-29 |
| 1407393754 | Valley Vascular Partners Inc | Radiology | 19231 Victory Blvd Ste 155, Reseda, CA 91335-6329 | 2017-01-25 |
| 1124497342 | Neurointerventional Surgery Consultants, PC | Radiology | 534 S Brea Blvd, Brea, CA 92821-5304 | 2015-09-17 |
| 1578946026 | Clarity Radiology, LLC | Radiology | 39 Via Navarro, Greenbrae, CA 94904-1215 | 2015-07-01 |
| 1669863981 | Pedes Vascular San Fernando Valley | Radiology | 16260 Ventura Boulevard, Suite 210, Encino, CA 91436-2203 | 2015-02-09 |
| Find all providers with the same taxonomy | ||||
| City | SANTA ROSA |
| Zip Code | 95405 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.