Individual
TAMARA R SHAFER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
3909 NEW VISION DR, FORT WAYNE, IN 46845-1725
(260) 469-6610
(260) 969-3065
Mailing address
11109 PARKVIEW PLAZA DR # 117, FORT WAYNE, IN 46845-1701
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
01087508A
IN
207Q00000X
Family Medicine Physician
Primary
2005021707
MO
207Q00000X
Family Medicine Physician
DR.0054578
CO
207Q00000X
Family Medicine Physician
MD150694
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
205484702
—
MO
05
—
500623126
—
OR
Enumeration date
11/06/2006
Last updated
10/15/2022
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