Provider Demographics
NPI:1033264957
Name:SHAFER, DREW M (PA-C)
Entity Type:Individual
Prefix:
First Name:DREW
Middle Name:M
Last Name:SHAFER
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:220 E ROWAN AVE
Mailing Address - Street 2:SUITE 120
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99207-1202
Mailing Address - Country:US
Mailing Address - Phone:509-489-2851
Mailing Address - Fax:509-484-0103
Practice Address - Street 1:220 E ROWAN AVE
Practice Address - Street 2:SUITE 120
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99207-1202
Practice Address - Country:US
Practice Address - Phone:509-489-2851
Practice Address - Fax:509-484-0103
Is Sole Proprietor?:No
Enumeration Date:2007-01-23
Last Update Date:2009-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPA10004471363AS0400X, 207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8360331Medicaid
WA27011OtherE WA GROUP HEALTH
WAAB36977Medicare ID - Type Unspecified
WA27011OtherE WA GROUP HEALTH
WA8360331Medicaid