Provider Demographics
NPI:1689636011
Name:SHAW, ALYSSA ANES (MD)
Entity type:Individual
Prefix:DR
First Name:ALYSSA
Middle Name:ANES
Last Name:SHAW
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:2003 KOOTENAI HEALTH WAY
Mailing Address - Street 2:
Mailing Address - City:COEUR D ALENE
Mailing Address - State:ID
Mailing Address - Zip Code:83814-6051
Mailing Address - Country:US
Mailing Address - Phone:208-625-5085
Mailing Address - Fax:208-625-5731
Practice Address - Street 1:914 W IRONWOOD DR STE 101
Practice Address - Street 2:
Practice Address - City:COEUR D ALENE
Practice Address - State:ID
Practice Address - Zip Code:83814
Practice Address - Country:US
Practice Address - Phone:208-625-3500
Practice Address - Fax:208-625-3501
Is Sole Proprietor?:No
Enumeration Date:2006-04-03
Last Update Date:2024-04-25
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CO42993207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine