Individual
MR. CASEY LEWIS SHAW
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
PA169608
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PA169608
MEDICAL LICENSE
OR
Enumeration date
03/13/2013
Last updated
10/02/2014
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