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Individual
VERNON ALLEN SHAW
Active
Individual
VERNON ALLEN SHAW
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CCC-A
Taxonomy
Speciality
Code
Description
License number
State
231H00000X
Audiologist
Primary
23001343A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000288063
ANTHEM
IN
05
—
200098570
—
IN
Enumeration date
01/18/2006
Last updated
07/22/2019
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