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Individual
JESSE DANIEL SHAW
Active
Individual
JESSE DANIEL SHAW
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.O
Taxonomy
Speciality
Code
Description
License number
State
207QS0010X
Sports Medicine (Family Medicine) Physician
Primary
9600
OK
207QS0010X
Sports Medicine (Family Medicine) Physician
O-1908
ID
207QS0010X
Sports Medicine (Family Medicine) Physician
Primary
OP61106819
WA
Other
Enumeration date
06/22/2011
Last updated
09/16/2026
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