Individual
DR. KILEY PATRICK SHAFER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2124 14TH ST, MERIDIAN, MS 39301-4040
(601) 553-6000
(601) 553-6115
Mailing address
355 AUDUBON CIR, BRANDON, MS 39047-7783
(601) 919-8036
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
19129
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
009937118
—
AL
05
—
06954074
—
MS
01
—
731-04414
BLUE CROSS BLUE SHIELD
AL
Enumeration date
07/12/2006
Last updated
07/08/2007
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