Provider Demographics
NPI:1891797536
Name:SHAFFER, ROBERT INGO (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:INGO
Last Name:SHAFFER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:ROBERT
Other - Middle Name:INGO
Other - Last Name:SHAFFER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:3640 YACHT CLUB DR
Mailing Address - Street 2:APT 104
Mailing Address - City:AVENTURA
Mailing Address - State:FL
Mailing Address - Zip Code:33180-3558
Mailing Address - Country:US
Mailing Address - Phone:786-942-6921
Mailing Address - Fax:
Practice Address - Street 1:4302 ALTON RD
Practice Address - Street 2:SUITE 300
Practice Address - City:MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33140-2891
Practice Address - Country:US
Practice Address - Phone:305-672-9989
Practice Address - Fax:786-245-2006
Is Sole Proprietor?:No
Enumeration Date:2005-08-12
Last Update Date:2014-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0064953207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL374403700Medicaid
FL262609800OtherGROUP MEDICAID
FL23782AOtherMEDICARE IND NUMBER
FLF73650Medicare UPIN
FL374403700Medicaid