Individual
DAVID DOUGLAS SHAW
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
CPO
Contact information
Practice address
312 COMMERCE ST, UNIT 10, WILLISTON, VT 05495-7832
(802) 864-9909
Mailing address
312 COMMERCE ST, UNIT 10, WILLISTON, VT 05495-7832
(802) 864-9909
Taxonomy
Speciality
Code
Description
License number
State
222Z00000X
Orthotist
—
—
224P00000X
Prosthetist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0009187
—
VT
05
—
01060791
—
NY
01
—
054 2771
BLUE CROSS BLUE SHIELD
VT
Enumeration date
01/31/2007
Last updated
03/19/2008
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