Provider Demographics
NPI:1265419030
Name:SHAFFER, VERNON C JR (MD)
Entity type:Individual
Prefix:DR
First Name:VERNON
Middle Name:C
Last Name:SHAFFER
Suffix:JR
Gender:M
Credentials:MD
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Mailing Address - Street 1:919 HIDDEN RDG
Mailing Address - Street 2:6TH FLOOR
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75038-3813
Mailing Address - Country:US
Mailing Address - Phone:469-282-2711
Mailing Address - Fax:469-282-0996
Practice Address - Street 1:2604 SAINT MICHAEL DR
Practice Address - Street 2:SUITE 410
Practice Address - City:TEXARKANA
Practice Address - State:TX
Practice Address - Zip Code:75503-2379
Practice Address - Country:US
Practice Address - Phone:903-614-5430
Practice Address - Fax:903-614-5464
Is Sole Proprietor?:No
Enumeration Date:2005-12-22
Last Update Date:2017-01-02
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Provider Licenses
StateLicense IDTaxonomies
TXG6012207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR110879001Medicaid
TX124647205Medicaid
TX124647202Medicaid
TX124647205Medicaid
B61855Medicare UPIN