Individual
JENNIFER GORDON SHAFER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.O.
Contact information
Practice address
2033 MEADOWVIEW LN, STE 200, KINGSPORT, TN 37660-7569
(423) 857-2260
(423) 857-2261
Mailing address
PO BOX 9, KINGSPORT, TN 37662-0009
(423) 857-2066
(423) 857-2070
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
2009-01172
NC
207Q00000X
Family Medicine Physician
Primary
DO2150
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1521048
—
TN
Enumeration date
08/31/2007
Last updated
02/02/2012
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