Provider Demographics
NPI:1518075043
Name:SHAFFER, STANLEY GLEN (MD)
Entity Type:Individual
Prefix:
First Name:STANLEY
Middle Name:GLEN
Last Name:SHAFFER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4401 WORNALL RD
Mailing Address - Street 2:SUITE 2718
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64111-3220
Mailing Address - Country:US
Mailing Address - Phone:816-932-2493
Mailing Address - Fax:816-932-6539
Practice Address - Street 1:4401 WORNALL RD
Practice Address - Street 2:SUITE 2718
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64111-3220
Practice Address - Country:US
Practice Address - Phone:816-932-2493
Practice Address - Fax:816-932-6539
Is Sole Proprietor?:No
Enumeration Date:2006-08-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MOR9B952080N0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal Medicine