Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207YX0007X | Plastic Surgeon (Head & Neck) | 0101245920 | VA |
NPI | 1629279047 |
---|---|
Provider Name | Travis Laron Shaw |
First Address | Richmond, VA 23235-1970 |
Second Address | Richmond, VA 23235-1970 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/05/2007 |
Last Update Date | 29/01/2013 |