Provider Demographics
NPI:1245296052
Name:SHAFFER, BRIAN L (MD)
Entity type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:L
Last Name:SHAFFER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:325 DISTEL CIR
Mailing Address - Street 2:
Mailing Address - City:LOS ALTOS
Mailing Address - State:CA
Mailing Address - Zip Code:94022-1408
Mailing Address - Country:US
Mailing Address - Phone:415-600-6400
Mailing Address - Fax:415-369-1384
Practice Address - Street 1:1100 VAN NESS AVE
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94109-6978
Practice Address - Country:US
Practice Address - Phone:415-600-6400
Practice Address - Fax:415-369-1384
Is Sole Proprietor?:No
Enumeration Date:2006-04-21
Last Update Date:2021-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA2009139207SG0201X
WAMD60278147207SG0201X, 207V00000X, 207VM0101X
ORMD153180207SG0201X, 207V00000X, 207VM0101X
CA854587207VM0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VM0101XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyMaternal & Fetal Medicine
No207SG0201XAllopathic & Osteopathic PhysiciansMedical GeneticsClinical Genetics (M.D.)
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA82583OtherSTATE MEDICAL LICENSE
ORMD153180OtherSTATE MEDICAL LICENSE
CA00A825830Medicaid
OR500627546Medicaid
CA00A825830Medicare PIN