Provider Demographics
NPI:1598762791
Name:SHAFFER, BRUCE A (MD)
Entity Type:Individual
Prefix:
First Name:BRUCE
Middle Name:A
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 1:1925 ASPEN DR
Mailing Address - Street 2:STE 802A
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87505-5577
Mailing Address - Country:US
Mailing Address - Phone:505-473-2972
Mailing Address - Fax:505-473-1759
Practice Address - Street 1:1925 ASPEN DR
Practice Address - Street 2:STE 802A
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87505-5577
Practice Address - Country:US
Practice Address - Phone:505-473-2972
Practice Address - Fax:505-473-1759
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-01
Last Update Date:2010-01-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NM86333207R00000X, 207RC0200X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NME22722Medicare UPIN