Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0120X | Pediatric Surgery | G43819 | CA |
NPI | 1063439602 |
---|---|
Provider Name | Dr. Anthony Shaw |
First Address | Pasadena, CA 91105 |
Second Address | Sylmar, CA 91342-1495 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/07/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
A49471 | (02) |