Individual
KYLE SHAFER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
176 1ST AVE N, ILWACO, WA 98624-9137
(360) 642-3747
Mailing address
35585 BELLA RIDGE LOOP, ASTORIA, OR 97103-6630
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
61076997
WA
Other
Enumeration date
04/07/2020
Last updated
07/22/2020
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