Provider Demographics
NPI:1033521075
Name:SHAFER, JOSEPH GRANT (AA-C)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:GRANT
Last Name:SHAFER
Suffix:
Gender:M
Credentials:AA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4222 BENT WOOD CT
Mailing Address - Street 2:
Mailing Address - City:ROUND ROCK
Mailing Address - State:TX
Mailing Address - Zip Code:78665-1176
Mailing Address - Country:US
Mailing Address - Phone:512-569-0393
Mailing Address - Fax:
Practice Address - Street 1:6414 FANNIN ST
Practice Address - Street 2:#G125
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-1517
Practice Address - Country:US
Practice Address - Phone:713-500-6930
Practice Address - Fax:713-500-5484
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-26
Last Update Date:2014-05-26
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367H00000XPhysician Assistants & Advanced Practice Nursing ProvidersAnesthesiologist Assistant