Provider Demographics
NPI:1720104243
Name:SHAEFFER, AUDREY R (DO)
Entity Type:Individual
Prefix:
First Name:AUDREY
Middle Name:R
Last Name:SHAEFFER
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9525 E OLD SPANISH TRL
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85748-6631
Mailing Address - Country:US
Mailing Address - Phone:520-731-3666
Mailing Address - Fax:
Practice Address - Street 1:9545 E OLD SPANISH TRL
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85748-6626
Practice Address - Country:US
Practice Address - Phone:520-731-3666
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-22
Last Update Date:2015-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ005750207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine