Provider Demographics
NPI:1417949983
Name:SHAFFER, MICHAEL D (DO)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:D
Last Name:SHAFFER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:575 HILL COUNTRY DR
Mailing Address - Street 2:
Mailing Address - City:KERRVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78028-6024
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1331 BANDERA HWY STE 4
Practice Address - Street 2:
Practice Address - City:KERRVILLE
Practice Address - State:TX
Practice Address - Zip Code:78028-9535
Practice Address - Country:US
Practice Address - Phone:830-258-7762
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-08-19
Last Update Date:2023-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34-009337207Q00000X
TXL6627207QS0010X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200036040AMedicaid
TX8M0733OtherHMO BLUE
NM90049OtherPRESBYTERIAN COMMERCIAL
TX167598501Medicaid
OH2839254Medicaid
TX139450100Medicaid
NM90049Medicaid
NM19229861Medicaid
TXP01527361OtherRAILROAD MEDICARE
TX167598506Medicaid
TX8FE660OtherBCBS
TX8M6326OtherBCBS
NMA030OtherTRIWEST
TX139450101OtherFIRSTCARE COMMERCIAL
TX167598508Medicaid
TX8JE232OtherBCBSTX - WCCA