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Individual

DAVID LEE SHAW

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
907 MAR WALT DRIVE, SUITE 2021, FORT WALTON BEACH, FL 32547-6960
(850) 863-0006
(850) 863-0012
Mailing address
907 MAR WALT DRIVE, SUITE 2021, FORT WALTON BEACH, FL 32547-6960
(850) 863-0006
(850) 863-0012

Taxonomy

Speciality
Code
Description
License number
State
2084N0400X
Neurology Physician
Primary
ME23236
FL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
17403
BCBS FL
FL
Enumeration date
08/31/2005
Last updated
11/28/2011
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