Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 213E00000X | Podiatrist | OI00000334 | WA |
N | 222Z00000X | Podiatrist | OI00000334 | WA |
Y | 224P00000X | Prosthetist | PS00000360 | WA |
NPI | 1376750695 |
---|---|
Provider Name | John David Shaffer |
First Address | Seattle, WA 98122-4148 |
Second Address | Seattle, WA 98105-3901 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/05/2007 |
Last Update Date | 20/03/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
256250001 | (02) | WA |