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General NPI Number Information
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NPI Number | 1336781905
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Entity Type | Individual
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Provider Name | JOE DEAN SHAW II
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Gender | Male
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Dates
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Enumeration Date | 10/15/2019
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Last Update Date | 10/09/2022
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Provider Practice Location Address
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Address Line | 820 15TH ST
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City | SPARKS
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State | NV
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Zip | 89431-0939
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Country | US
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Telephone | 775-378-1916
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Fax |
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Provider Business Mailing Address
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Address Line | 10060 RACCOON CT
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City | RENO
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State | NV
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Zip | 89523-9605
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Country | US
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Telephone | 775-378-1916
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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 | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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