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General NPI Number Information
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NPI Number | 1265672117
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Entity Type | Organization
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Legal Business Name | DR. MICHAEL P. SHAW, A PROFESSIONAL CORPORATION, INC.
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Dates
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Enumeration Date | 03/04/2009
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Last Update Date | 03/04/2009
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Provider Practice Location Address
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Address Line | 2020 STANDIFORD AVE STE B
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City | MODESTO
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State | CA
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Zip | 95350-6530
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Country | US
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Telephone | 209-522-9339
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Fax | 209-525-9366
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Provider Business Mailing Address
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Address Line | 222 MEMORY LN
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City | TURLOCK
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State | CA
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Zip | 95382-7272
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Country | US
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Telephone | 209-667-9339
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Fax | 209-664-0505
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Authorized Official
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Title or Position | PRACTICE ADMINISTRATOR
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Name | ELIZABETH S. SHAW
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Credential |
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Telephone | 209-667-9339
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 35996
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License Number State | CA
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