Provider Demographics
NPI:1598721938
Name:SHAVER, WILLIAM A (MD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:A
Last Name:SHAVER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2405 BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79401-2918
Mailing Address - Country:US
Mailing Address - Phone:806-799-3644
Mailing Address - Fax:806-791-3204
Practice Address - Street 1:2405 BROADWAY ST
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79401-2918
Practice Address - Country:US
Practice Address - Phone:806-799-3644
Practice Address - Fax:806-791-3204
Is Sole Proprietor?:No
Enumeration Date:2006-04-25
Last Update Date:2024-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG0104174400000X, 207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX123796801Medicaid
8346J0Medicare ID - Type Unspecified
TX123796801Medicaid