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1063973790
CODY EUGENE SHAW
GROTON, CT
NPI
1063973790
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
No
Primary Taxonomy
1710I1002X Military Health Care Provider, Independent Duty Corpsman
Enumeration Date
2019-03-26
Last Update Date
2019-03-26
Business Address
CODY EUGENE SHAW
NUMI TROUT AVE BUILDING 83
GROTON, CT 06340
Phone number: 860-694-2876
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Mailing Address
CODY EUGENE SHAW
5 WELLS ST
GROTON, CT 06340-3336
Phone number: 682-553-2447
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