Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213ES0103X | Foot & Ankle Surgery | POD000585 | GA |
NPI | 1023015146 |
---|---|
Provider Name | Dr. Mark William Shaffer |
First Address | Monroe, GA 30655-8211 |
Second Address | Monroe, GA 30655-8211 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/07/2005 |
Last Update Date | 20/09/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00401497B | (05) | GA |
00401497C | (05) | GA |
U09954 | (02) | GA |