Individual
LAURENCE DUANE SHAW
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
15107 VANOWEN ST, VAN NUYS, CA 91405-4542
(818) 902-2978
Mailing address
PO BOX 1359, SAN CLEMENTE, CA 92674-1359
(949) 492-3514
(949) 366-2390
Taxonomy
Speciality
Code
Description
License number
State
2080N0001X
Neonatal-Perinatal Medicine Physician
Primary
G35656
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00G356560
—
CA
01
—
G356560
MEDICAL LICENSE
CA
Enumeration date
09/28/2006
Last updated
07/09/2007
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