Provider Demographics
NPI:1801837737
Name:SHAFF, DENISE LORRAINE (MD)
Entity Type:Individual
Prefix:
First Name:DENISE
Middle Name:LORRAINE
Last Name:SHAFF
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5711 LONGMONT LN
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77057-2509
Mailing Address - Country:US
Mailing Address - Phone:832-477-1505
Mailing Address - Fax:713-785-1557
Practice Address - Street 1:5711 LONGMONT LN
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77057-2509
Practice Address - Country:US
Practice Address - Phone:832-477-1505
Practice Address - Fax:713-785-1557
Is Sole Proprietor?:No
Enumeration Date:2006-06-10
Last Update Date:2008-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF4513207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXF4513OtherLICENCE
TXF4513OtherLICENCE
P00386034Medicare PIN
TX8J1395Medicare PIN