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General NPI Number Information
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NPI Number | 1164230454
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Entity Type | Individual
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Provider Name | AUSTIN SHAW PA
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Gender | Male
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Dates
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Enumeration Date | 12/19/2024
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Last Update Date | 12/19/2024
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Provider Practice Location Address
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Address Line | 205 MAIN ST
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City | AUMSVILLE
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State | OR
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Zip | 97325-9018
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Country | US
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Telephone | 503-749-4734
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Fax |
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Provider Business Mailing Address
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Address Line | 6 EGRET CV
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City | CAMDEN
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State | SC
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Zip | 29020-8422
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Country | US
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Telephone | 215-740-2779
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number |
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License Number State |
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