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NPI Code Detail

MEDICARE: WILLIAM J SHAW IV PA-C

MEDICARE: WILLIAM J SHAW IV PA-C
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363A00000XPhysician AssistantPA04686TX

General Provider Information

NPI Number : 1134258163
Entity Type Code : Individual
Provider Name (Legal Business Name) : WILLIAM J SHAW IV PA-C
Provider Business Mailing Address
First Line : 2901 ACME BRICK PLZ
Second Line :
City : FORT WORTH
State : TX
Zip : 76109-4124
Country : US
Telephone Number : 817-529-1900
Fax Number : 817-529-1910
Provider Business Practice Location Address
First Line : 2901 ACME BRICK PLZ
Second Line :
City : FORT WORTH
State : TX
Zip : 76109-4124
Country : US
Telephone Number : 817-529-1900
Fax Number : 817-529-1910
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/05/2007
Last Update Date : 11/06/2024

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Directions to “ WILLIAM J SHAW IV PA-C” Practice Location

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