Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Y00000X | Otolaryngologist (ENT Doctor) | 23875 | WV |
NPI | 1033381801 |
---|---|
Provider Name | Marcus Doddridge Shaffer |
First Address | Charleston, WV 25302-3390 |
Second Address | Charleston, WV 25302-3302 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/04/2008 |
Last Update Date | 21/12/2015 |