Provider Demographics
NPI:1528042702
Name:SHAFOR, ROBERT V (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:V
Last Name:SHAFOR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1051 GAUSE BLVD STE 410
Mailing Address - Street 2:
Mailing Address - City:SLIDELL
Mailing Address - State:LA
Mailing Address - Zip Code:70458-2995
Mailing Address - Country:US
Mailing Address - Phone:985-280-9002
Mailing Address - Fax:985-781-0200
Practice Address - Street 1:1051 GAUSE BLVD STE 410
Practice Address - Street 2:
Practice Address - City:SLIDELL
Practice Address - State:LA
Practice Address - Zip Code:70458-2995
Practice Address - Country:US
Practice Address - Phone:985-280-9002
Practice Address - Fax:985-781-0200
Is Sole Proprietor?:No
Enumeration Date:2005-12-01
Last Update Date:2020-01-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
LA10412R208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1801020433OtherNPI SMH PHYSICIAN NETWORK
LA1539562Medicaid
020023590OtherRAILROAD MEDICARE
LA1539562Medicaid
020023590OtherRAILROAD MEDICARE