# JESSE DANIEL SHAW

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** Yes

## Provider details

- **NPI number:** 1912293572
- **Gender:** Man
- **Credential:** D.O

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207QS0010X | Sports Medicine (Family Medicine) Physician | 9600 | OK | Yes |
| 207QS0010X | Sports Medicine (Family Medicine) Physician | O-1908 | ID | — |
| 207QS0010X | Sports Medicine (Family Medicine) Physician | OP61106819 | WA | Yes |

## Other

- **Enumeration date:** 06/22/2011
- **Last updated:** 09/16/2026