Provider Demographics
NPI:1013962240
Name:SHAFFER, PEGGY MARIE (MD)
Entity Type:Individual
Prefix:DR
First Name:PEGGY
Middle Name:MARIE
Last Name:SHAFFER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:PEGGY
Other - Middle Name:MARIE
Other - Last Name:MORRILL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:3460 RIDGECREST DR.
Mailing Address - Street 2:
Mailing Address - City:CARLSBAD
Mailing Address - State:CA
Mailing Address - Zip Code:92008
Mailing Address - Country:US
Mailing Address - Phone:760-720-3345
Mailing Address - Fax:
Practice Address - Street 1:NAVAL HOSPITAL, CAMP PENDLETON ATTN: CODE 094
Practice Address - Street 2:BLDG H100
Practice Address - City:CAMP PENDLETON
Practice Address - State:CA
Practice Address - Zip Code:92055-5191
Practice Address - Country:US
Practice Address - Phone:760-725-8882
Practice Address - Fax:760-725-1267
Is Sole Proprietor?:No
Enumeration Date:2006-05-24
Last Update Date:2015-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG85876208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics