Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0122X | Plastic and Reconstructive Surgery | 79920 | MA |
NPI | 1083698112 |
---|---|
Provider Name | Dr. John V Shufflebarger |
First Address | Boston, MA 02241-0001 |
Second Address | Worcester, MA 01605-2138 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/12/2005 |
Last Update Date | 27/10/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
3130100 | (05) | MA |
F97107 | (02) | MA |