Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RR0500X | Rheumatology | 11749246-1205 | UT |
NPI | 1104359561 |
---|---|
Provider Name | Andrew B. Shaffer |
First Address | Sandy, UT 84070-3810 |
Second Address | Salt Lake City, UT 84132-0002 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/04/2017 |
Last Update Date | 05/09/2021 |