Provider Demographics
NPI:1093845687
Name:ROBERT V SHAFOR, MD
Entity Type:Organization
Organization Name:ROBERT V SHAFOR, MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:V
Authorized Official - Last Name:SHAFOR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:985-781-9004
Mailing Address - Street 1:1051 GAUSE BLVD
Mailing Address - Street 2:SUITE 260
Mailing Address - City:SLIDELL
Mailing Address - State:LA
Mailing Address - Zip Code:70458-2951
Mailing Address - Country:US
Mailing Address - Phone:985-781-9004
Mailing Address - Fax:985-781-0200
Practice Address - Street 1:1051 GAUSE BLVD
Practice Address - Street 2:SUITE 260
Practice Address - City:SLIDELL
Practice Address - State:LA
Practice Address - Zip Code:70458-2951
Practice Address - Country:US
Practice Address - Phone:985-781-9004
Practice Address - Fax:985-781-0200
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-06
Last Update Date:2010-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD.10412R208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1539562Medicaid
LA020023590OtherRAILROAD MEDICARE
LA020023590OtherRAILROAD MEDICARE
LA5U413Medicare PIN