Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 156FX1100X | Ophthalmic | 5934A | WY |
Y | 207W00000X | Ophthalmologist | 5934A | WY |
NPI | 1730181561 |
---|---|
Provider Name | Dr. Shaun Stuart Shafer |
First Address | Laramie, WY 82070-5103 |
Second Address | Laramie, WY 82070-5103 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/08/2005 |
Last Update Date | 19/12/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
118240400 | (05) | WY |
180046305 | RAILROAD MEDICARE (01) | |
G03075 | (02) |