Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207N00000X | Dermatologist | 0429936 | KS |
Y | 207ND0101X | MOHS-Micrographic Surgeon | 0429936 | KS |
N | 207ND0900X | Dermatopathologist | 0429936 | KS |
NPI | 1487620167 |
---|---|
Provider Name | Matthew P Shaffer |
First Address | Salina, KS 67401-7406 |
Second Address | Salina, KS 67401-7406 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/02/2006 |
Last Update Date | 28/09/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
103734 | BCBS (HAYS LOCATION) (01) | KS |
103735 | BCBS (GREAT BEND LOCATION (01) | KS |
103745 | BCBS (SALINA LOCATION) (01) | KS |
623450 | FIRST GUARD (01) | KS |
P00154203 | TRAVELERS MEDICARE (01) | KS |