Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207PE0004X | Emergency Medical Services | OS004233L | PA |
NPI | 1174531461 |
---|---|
Provider Name | Donald D Shaw |
First Address | Wellsboro, PA 16901-1840 |
Second Address | Wellsboro, PA 16901-1840 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/08/2006 |
Last Update Date | 16/04/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0007174090001 | (05) | PA |
217744 | UPMC (01) | PA |
C31766 | (02) | |
SH145926 | BC/BS (01) | PA |