Provider Demographics
NPI:1790877512
Name:HEATHER SHAFFER MD PA
Entity Type:Organization
Organization Name:HEATHER SHAFFER MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:HEATHER
Authorized Official - Middle Name:S
Authorized Official - Last Name:ZAWAHRY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:850-785-3464
Mailing Address - Street 1:PO BOX 1280
Mailing Address - Street 2:
Mailing Address - City:PANAMA CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32402-1280
Mailing Address - Country:US
Mailing Address - Phone:850-785-3464
Mailing Address - Fax:850-785-2791
Practice Address - Street 1:1937 HARRISON AVE
Practice Address - Street 2:
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32405-4543
Practice Address - Country:US
Practice Address - Phone:850-785-3464
Practice Address - Fax:850-785-2791
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-29
Last Update Date:2013-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME84800207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL267798900Medicaid
FL81116OtherBCBS OF FLORIDA
FL81116OtherBCBS OF FLORIDA
FLAC535Medicare PIN