Individual
DALTON S SHAW
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
100 PAR LN, ELIZABETHTOWN, KY 42701-9023
(270) 312-2500
Mailing address
211 PONDEROSA DR, ELIZABETHTOWN, KY 42701-2668
(270) 801-3237
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
Primary
1202722
KY
Other
Enumeration date
01/23/2025
Last updated
01/28/2025
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