Provider Demographics
NPI:1760379937
Name:SHAFFER, ROBERT GLENN
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:GLENN
Last Name:SHAFFER
Suffix:
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 1:15535 SOFTWOOD RD
Mailing Address - Street 2:
Mailing Address - City:ELBERT
Mailing Address - State:CO
Mailing Address - Zip Code:80106-9077
Mailing Address - Country:US
Mailing Address - Phone:719-322-8063
Mailing Address - Fax:
Practice Address - Street 1:15535 SOFTWOOD RD
Practice Address - Street 2:
Practice Address - City:ELBERT
Practice Address - State:CO
Practice Address - Zip Code:80106-9077
Practice Address - Country:US
Practice Address - Phone:719-322-8063
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-20
Last Update Date:2025-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory