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Individual

DERRICK CHASE SHAW

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man

Contact information

Practice address
1185 CORDOVA DR, LUSBY, MD 20657-4538
(402) 705-3896
Mailing address
1185 CORDOVA DR, LUSBY, MD 20657-4538
(402) 705-3896

Taxonomy

Speciality
Code
Description
License number
State
1710I1003X
Independent Duty Medical Technicians
Primary

Other

Enumeration date
10/13/2022
Last updated
04/04/2023
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