Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207L00000X | Anesthesiologist | 23005 | NE |
NPI | 1013120492 |
---|---|
Provider Name | Robert R Shaffer |
First Address | Kearney, NE 68848-0963 |
Second Address | Kearney, NE 68847 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/05/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
23005 | PHYSICIAN (01) | NE |