Provider Demographics
NPI:1700399714
Name:SHAFER, GEORGE FREDRICK JR
Entity Type:Individual
Prefix:
First Name:GEORGE
Middle Name:FREDRICK
Last Name:SHAFER
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10710 DEER PATH RD
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73025-5815
Mailing Address - Country:US
Mailing Address - Phone:405-200-4058
Mailing Address - Fax:
Practice Address - Street 1:12250 S KELLY AVE
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73025-1903
Practice Address - Country:US
Practice Address - Phone:405-200-4058
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-11-13
Last Update Date:2017-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist