Jacob R Shaw

NPI #1396513719 in Basin, Wyoming

Provider Information

NPI Number
1396513719
Entity Type
Individual
Name
Jacob R Shaw
Gender
Not Specified
Sole Proprietor
No
Primary Specialty
Peer Specialist
Enumeration Date
Dec 14, 2023
Last Updated
Dec 14, 2023

Practice Location

Address
116 SOUTH 3RD STREET
City
Basin
State
Wyoming
ZIP Code
82410
Phone
(307) 568-2020

Specialties & Taxonomy Codes

Specialty
Peer Specialist

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