Provider Demographics
NPI:1922008176
Name:SHAFFER, DANA C (DO)
Entity Type:Individual
Prefix:DR
First Name:DANA
Middle Name:C
Last Name:SHAFFER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 2917
Mailing Address - Street 2:
Mailing Address - City:PIKEVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:41502-2917
Mailing Address - Country:US
Mailing Address - Phone:606-218-4800
Mailing Address - Fax:606-218-4810
Practice Address - Street 1:184 S MAYO TRL
Practice Address - Street 2:
Practice Address - City:PIKEVILLE
Practice Address - State:KY
Practice Address - Zip Code:41501-1518
Practice Address - Country:US
Practice Address - Phone:606-218-4800
Practice Address - Fax:606-218-4810
Is Sole Proprietor?:No
Enumeration Date:2005-07-29
Last Update Date:2014-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA02167207Q00000X
KY03636207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0237305Medicaid
IA0237305Medicaid
IAD46549Medicare UPIN