Provider Demographics
NPI:1295712164
Name:SCHAFFER, SHIRL L (MD)
Entity type:Individual
Prefix:
First Name:SHIRL
Middle Name:L
Last Name:SCHAFFER
Suffix:
Gender:F
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:PO BOX 840857
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-0857
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:9127 W RUSSELL RD STE 110
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89148-1253
Practice Address - Country:US
Practice Address - Phone:702-878-0070
Practice Address - Fax:303-780-0787
Is Sole Proprietor?:No
Enumeration Date:2005-12-30
Last Update Date:2022-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO39821207L00000X
MT114691207L00000X
NV21813207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO04204549Medicaid
KS100457880AMedicaid
NE84113438513Medicaid
MT3506685Medicaid
NM40755738Medicaid
WY116784700Medicaid
WY116784700Medicaid
COC500628Medicare PIN
P00031085Medicare PIN