Provider Demographics
NPI:1750569679
Name:JAMES W. SHOFFER, DPM, PC
Entity type:Organization
Organization Name:JAMES W. SHOFFER, DPM, PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:SHOFFER
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:623-825-9309
Mailing Address - Street 1:6525 W SACK DR
Mailing Address - Street 2:SUITE 102
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85308-7104
Mailing Address - Country:US
Mailing Address - Phone:623-825-9309
Mailing Address - Fax:623-566-3570
Practice Address - Street 1:6525 W SACK DR
Practice Address - Street 2:SUITE 102
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85308-7104
Practice Address - Country:US
Practice Address - Phone:623-825-9309
Practice Address - Fax:623-566-3570
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-01
Last Update Date:2008-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ1300210001Medicare NSC