Provider Demographics
NPI:1619187523
Name:SHAFFER, BRETT MICHAEL (MD)
Entity Type:Individual
Prefix:DR
First Name:BRETT
Middle Name:MICHAEL
Last Name:SHAFFER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:BRETT
Other - Middle Name:MICHAEL
Other - Last Name:SHAFFER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:3526 BECKET ST NE
Mailing Address - Street 2:
Mailing Address - City:LACEY
Mailing Address - State:WA
Mailing Address - Zip Code:98516-6291
Mailing Address - Country:US
Mailing Address - Phone:240-418-1515
Mailing Address - Fax:
Practice Address - Street 1:1299 BISHOP RD
Practice Address - Street 2:
Practice Address - City:CHEHALIS
Practice Address - State:WA
Practice Address - Zip Code:98532-8758
Practice Address - Country:US
Practice Address - Phone:360-740-4001
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-23
Last Update Date:2020-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD.MD.60196368207P00000X
SD11754207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine