Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN1001X | Nutrition | DC001204L | PA |
NPI | 1013076884 |
---|---|
Provider Name | Dr. William King Shaffer |
First Address | Mechanicsburg, PA 17050-2401 |
Second Address | Mechanicsburg, PA 17050-2401 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/12/2006 |
Last Update Date | 08/07/2007 |