Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2084N0400X | Neurologist | ME0072261 | FL |
NPI | 1003818816 |
---|---|
Provider Name | Dr. Stuart J Shafer |
First Address | Vero Beach, FL 32960-4818 |
Second Address | Vero Beach, FL 32960-4818 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/08/2005 |
Last Update Date | 06/02/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
21022 | BC BS (01) | FL |
252717100 | (05) | FL |
G51172 | (02) | FL |