Individual
REBECCA D SHAW
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CFA
Contact information
Practice address
3630 E LOUISE DR, MERIDIAN, ID 83642-7975
(208) 377-9515
Mailing address
3630 E LOUISE DR, MERIDIAN, ID 83642-7975
(208) 377-9515
Taxonomy
Speciality
Code
Description
License number
State
2086S0122X
Plastic and Reconstructive Surgery Physician
Primary
M-8189
ID
Other
Enumeration date
02/09/2009
Last updated
02/09/2009
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