# SHAWN ERIK TEDFORD

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** No

## Provider details

- **NPI number:** 1063449072
- **Gender:** Man
- **Credential:** PA-C

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 363A00000X | Physician Assistant | PA10003756 | WA | Yes |
| 363A00000X | Physician Assistant | PA2007-0004 | NM | — |
| 363AM0700X | Medical Physician Assistant | PA2007-0004 | NM | — |
| 363AS0400X | Surgical Physician Assistant | PA2007-0004 | NM | — |

## Other

- **Enumeration date:** 06/26/2006
- **Last updated:** 03/07/2023

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 1001498 | — | WA |
| 01 | — | 205198 | LABOR & INDUSTRIES | WA |
| 01 | — | 8918TE | REGENCE BLUESHIELD | — |
| 01 | — | 8942304 | CRIME VICTIMS COMP | WA |
| 01 | — | P00330803 | RAILROAD MEDICARE | — |