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Individual

SAMUEL G SHAVER

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
1601 MEDICAL ARTS BLVD, SUITE 100, ANDERSON, IN 46011-3458
(765) 298-5700
(765) 298-4913
Mailing address
6626 E 75TH ST, SUITE 500, INDIANAPOLIS, IN 46250-2805

Taxonomy

Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
01075554A
IN
207Q00000X
Family Medicine Physician
11016928A
IN

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
201097800
IN
01
P01588256
RR MEDICARE
IN
Enumeration date
09/14/2012
Last updated
11/27/2023
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