Individual
JACOB R SHAW
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
116 SOUTH 3RD STREET, BASIN, WY 82410
(307) 568-2020
Mailing address
1114 LANE 12, LOVELL, WY 82431-9555
(307) 548-6543
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
Primary
143
WY
Other
Enumeration date
12/14/2023
Last updated
12/14/2023
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