Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208G00000X | Cardiothoracic Vascular Surgeon | Q9902 | TX |
NPI | 1144475229 |
---|---|
Provider Name | Dr. Justin Michael Schaffer |
First Address | Dallas, TX 75209-7323 |
Second Address | Plano, TX 75093-5371 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/11/2008 |
Last Update Date | 09/09/2016 |