Individual
JACOB ISRAEL SHAW
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
789 PINE ST, BURLINGTON, VT 05401-4924
(802) 864-0693
(028) 606-6138
Mailing address
617 RIVERSIDE AVE, BURLINGTON, VT 05401-1601
(802) 864-0693
(708) 763-7232
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
036144497
IL
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
05/19/2015
Last updated
02/11/2021
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