Provider Demographics
NPI:1801044722
Name:SHAFFER, WILLIAM R (MD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:R
Last Name:SHAFFER
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:2315 E HARMONY RD
Mailing Address - Street 2:SUITE 110
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80528-8620
Mailing Address - Country:US
Mailing Address - Phone:970-482-4373
Mailing Address - Fax:970-484-5682
Practice Address - Street 1:2315 E HARMONY RD
Practice Address - Street 2:SUITE 110
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80528-8620
Practice Address - Country:US
Practice Address - Phone:970-482-4373
Practice Address - Fax:970-484-5682
Is Sole Proprietor?:No
Enumeration Date:2008-09-04
Last Update Date:2017-04-13
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CO476692084N0400X
IL036.1213842084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
COCO305154Medicare PIN
CO555299YLB8Medicare PIN