Individual
MR. SHANE A LACAILLADE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
IDMT
Contact information
Practice address
331 SIJAN AVE, WHITEMAN AFB, MO 65305-1269
(660) 687-1191
Mailing address
1307 SHAMROCK CT, WARRENSBURG, MO 64093-2490
(660) 747-3477
Taxonomy
Speciality
Code
Description
License number
State
1710I1003X
Independent Duty Medical Technicians
Primary
—
—
Other
Enumeration date
05/27/2009
Last updated
05/27/2009
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