Individual
MARK CAL SHAW
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
402 SECOND ST., BERNICE, LA 71222
(318) 285-9066
(318) 285-9065
Mailing address
741 HIDDEN VALLEY DR., GARRISON, TX 75946
(936) 715-9869
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
M9001
TX
207Q00000X
Family Medicine Physician
Primary
MD023225
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1495611
—
LA
Enumeration date
05/11/2006
Last updated
10/07/2015
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