Individual
MARY J SHAVER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
2445 CHRISTINA LN STE B, CONWAY, AR 72034-7047
(501) 279-7077
(501) 279-3970
Mailing address
PO BOX 17930, LITTLE ROCK, AR 72222-7930
(501) 663-0490
(501) 663-5948
Taxonomy
Speciality
Code
Description
License number
State
207RN0300X
Nephrology Physician
Primary
C-8466
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
134970001
—
AR
Enumeration date
10/31/2005
Last updated
04/16/2021
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