Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0106X | Oral and Maxillofacial Pathology | DW035996 | CA |
NPI | 1679594113 |
---|---|
Provider Name | Dr. Michael P. Shaw |
First Address | Turlock, CA 95382-7272 |
Second Address | Modesto, CA 95350-6530 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/07/2006 |
Last Update Date | 08/07/2007 |