Provider Demographics
NPI:1235219189
Name:SHAUN S SHAFER MD PC
Entity Type:Organization
Organization Name:SHAUN S SHAFER MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SHAUN
Authorized Official - Middle Name:S
Authorized Official - Last Name:SHAFER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:307-742-2131
Mailing Address - Street 1:204 MCCOLLUM DRIVE #201
Mailing Address - Street 2:
Mailing Address - City:LARAMIE
Mailing Address - State:WY
Mailing Address - Zip Code:82072
Mailing Address - Country:US
Mailing Address - Phone:307-742-2131
Mailing Address - Fax:307-742-2134
Practice Address - Street 1:204 MCCOLLUM DRIVE #201
Practice Address - Street 2:
Practice Address - City:LARAMIE
Practice Address - State:WY
Practice Address - Zip Code:82072
Practice Address - Country:US
Practice Address - Phone:307-742-2131
Practice Address - Fax:307-742-2134
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-16
Last Update Date:2007-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY5934A174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY118240400Medicaid
WYG03075Medicare UPIN
WYW9520Medicare PIN