Individual
MR. JACOB MICHAEL SHAW
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
16777 MEDICAL CENTER DR, BATON ROUGE, LA 70816-3254
(225) 761-5200
(225) 754-5052
Mailing address
16777 MEDICAL CENTER DR, BATON ROUGE, LA 70816-3254
(225) 761-5200
(225) 754-5052
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
320113
LA
Other
Enumeration date
08/05/2019
Last updated
12/21/2022
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