Provider Demographics
NPI:1770930711
Name:SHAFER, PAUL WILLIAM
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:WILLIAM
Last Name:SHAFER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14399 VISTA DEL SOL LN
Mailing Address - Street 2:
Mailing Address - City:ADELANTO
Mailing Address - State:CA
Mailing Address - Zip Code:92301-4623
Mailing Address - Country:US
Mailing Address - Phone:760-812-4165
Mailing Address - Fax:
Practice Address - Street 1:14399 VISTA DEL SOL LN
Practice Address - Street 2:
Practice Address - City:ADELANTO
Practice Address - State:CA
Practice Address - Zip Code:92301-4623
Practice Address - Country:US
Practice Address - Phone:760-812-4165
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-19
Last Update Date:2016-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)