Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 204D00000X | Neuromusculoskeletal Medicine (NMM) | Q5928 | TX |
N | 207Q00000X | Family Doctor | 274855 | NY |
Y | 207Q00000X | Family Doctor | Q5928 | TX |
NPI | 1194075101 |
---|---|
Provider Name | Christie Peer Shanafelt |
First Address | Fort Worth, TX 76199-0335 |
Second Address | Fort Worth, TX 76107-2553 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/09/2012 |
Last Update Date | 04/12/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
350236101 | (05) | TX |
8FM865 | BCBS (01) | TX |