Provider Demographics
NPI:1982054433
Name:SHAFER, BRIAN MICHAEL (MD)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:MICHAEL
Last Name:SHAFER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1104 MORTON ALY
Mailing Address - Street 2:
Mailing Address - City:KING OF PRUSSIA
Mailing Address - State:PA
Mailing Address - Zip Code:19406-2492
Mailing Address - Country:US
Mailing Address - Phone:267-210-2169
Mailing Address - Fax:
Practice Address - Street 1:633 W GERMANTOWN PIKE STE 100
Practice Address - Street 2:
Practice Address - City:PLYMOUTH MEETING
Practice Address - State:PA
Practice Address - Zip Code:19462-1032
Practice Address - Country:US
Practice Address - Phone:484-681-2305
Practice Address - Fax:215-714-9711
Is Sole Proprietor?:No
Enumeration Date:2016-06-15
Last Update Date:2023-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD474851207WX0120X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes207WX0120XAllopathic & Osteopathic PhysiciansOphthalmologyCornea and External Diseases Specialist