Provider Demographics
NPI:1588844435
Name:ALFRET SHAKESPRERE
Entity Type:Organization
Organization Name:ALFRET SHAKESPRERE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ALFRET
Authorized Official - Middle Name:NORMAN
Authorized Official - Last Name:SHAKESPRERE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:304-728-9797
Mailing Address - Street 1:201 E 5TH AVE
Mailing Address - Street 2:
Mailing Address - City:RANSON
Mailing Address - State:WV
Mailing Address - Zip Code:25438-1678
Mailing Address - Country:US
Mailing Address - Phone:304-728-9797
Mailing Address - Fax:
Practice Address - Street 1:201 E 5TH AVE
Practice Address - Street 2:
Practice Address - City:RANSON
Practice Address - State:WV
Practice Address - Zip Code:25438-1678
Practice Address - Country:US
Practice Address - Phone:304-728-9797
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-08
Last Update Date:2008-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV19076207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0080920000Medicaid
WV0080920000Medicaid