Provider Demographics
NPI:1326187188
Name:SHAEFFER, JAMES T (MD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:T
Last Name:SHAEFFER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:4049 S CAMPBELL AVE
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65807-5303
Mailing Address - Country:US
Mailing Address - Phone:417-890-5550
Mailing Address - Fax:417-889-6898
Practice Address - Street 1:4049 S CAMPBELL AVE
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65807-5303
Practice Address - Country:US
Practice Address - Phone:417-890-5550
Practice Address - Fax:417-889-6898
Is Sole Proprietor?:No
Enumeration Date:2007-02-06
Last Update Date:2011-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR5045207Q00000X, 207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO200005502Medicaid
MO81634OtherAR BLUE SHIELD #
MO226013268Medicare ID - Type UnspecifiedMO MDCR #
MO81634OtherAR BLUE SHIELD #