Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2084N0400X | Neurologist | 40057 | KY |
NPI | 1003876822 |
---|---|
Provider Name | Dr. Christopher R. Shafer |
First Address | Louisville, KY 40201-0909 |
Second Address | Louisville, KY 40202-5710 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/03/2006 |
Last Update Date | 14/03/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
200822640 | (05) | IN |
40057 | LICENSE (01) | KY |
64124126 | (05) | KY |
I52519 | (02) | KY |