Provider Demographics
NPI:1760787451
Name:SHAW, DAVID WAYNE (CRNA)
Entity type:Individual
Prefix:MR
First Name:DAVID
Middle Name:WAYNE
Last Name:SHAW
Suffix:
Gender:M
Credentials:CRNA
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Mailing Address - Street 1:4515 MARSHA SHARP FWY
Mailing Address - Street 2:GRACE CLINIC OF LUBBOCK
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79407
Mailing Address - Country:US
Mailing Address - Phone:806-744-7223
Mailing Address - Fax:806-740-3325
Practice Address - Street 1:7509 MARSHA SHARP FWY
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79407-8202
Practice Address - Country:US
Practice Address - Phone:806-744-7223
Practice Address - Fax:806-740-3325
Is Sole Proprietor?:No
Enumeration Date:2011-01-11
Last Update Date:2024-09-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TX688169367500000X
TXAP119964367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered