Individual
MICAH SHAW
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
2211 LOMAS BLVD NE, ALBUQUERQUE, NM 87106-2719
(505) 272-2111
Mailing address
800 BRADBURY DR SE STE 116, ALBUQUERQUE, NM 87106-4310
(505) 272-1476
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA2016-0072
NM
Other
Enumeration date
09/09/2016
Last updated
10/23/2024
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