Provider Demographics
NPI:1629239801
Name:SHEFFLER, JASON RAY (DO)
Entity Type:Individual
Prefix:DR
First Name:JASON
Middle Name:RAY
Last Name:SHEFFLER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1115 S MARSHALL ST
Mailing Address - Street 2:
Mailing Address - City:BOONE
Mailing Address - State:IA
Mailing Address - Zip Code:50036-5304
Mailing Address - Country:US
Mailing Address - Phone:515-432-2335
Mailing Address - Fax:515-432-2357
Practice Address - Street 1:1115 S MARSHALL ST
Practice Address - Street 2:
Practice Address - City:BOONE
Practice Address - State:IA
Practice Address - Zip Code:50036-5304
Practice Address - Country:US
Practice Address - Phone:515-432-2335
Practice Address - Fax:515-432-2357
Is Sole Proprietor?:No
Enumeration Date:2008-06-20
Last Update Date:2015-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA4262207Q00000X
MI5101017904390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAI66410009Medicare PIN