Provider Demographics
NPI:1194845776
Name:JAMES S. SHAFER, M.D.
Entity Type:Organization
Organization Name:JAMES S. SHAFER, M.D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:S
Authorized Official - Last Name:SHAFER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:626-332-6238
Mailing Address - Street 1:203 W BADILLO ST
Mailing Address - Street 2:
Mailing Address - City:COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91723-1907
Mailing Address - Country:US
Mailing Address - Phone:626-332-6238
Mailing Address - Fax:626-332-1044
Practice Address - Street 1:203 W BADILLO ST
Practice Address - Street 2:
Practice Address - City:COVINA
Practice Address - State:CA
Practice Address - Zip Code:91723-1907
Practice Address - Country:US
Practice Address - Phone:626-332-6238
Practice Address - Fax:626-332-1044
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-29
Last Update Date:2008-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC26610207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00C266100Medicaid
CA00C266100OtherBLUE SHIELD
CAW4561Medicare PIN
CA00C266100OtherBLUE SHIELD