Provider Demographics
NPI:1336781905
Name:SHAW, JOE DEAN II
Entity Type:Individual
Prefix:
First Name:JOE
Middle Name:DEAN
Last Name:SHAW
Suffix:II
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10060 RACCOON CT
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89523-9605
Mailing Address - Country:US
Mailing Address - Phone:775-378-1916
Mailing Address - Fax:
Practice Address - Street 1:820 15TH ST
Practice Address - Street 2:
Practice Address - City:SPARKS
Practice Address - State:NV
Practice Address - Zip Code:89431-0939
Practice Address - Country:US
Practice Address - Phone:775-378-1916
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-15
Last Update Date:2022-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program