Individual
JOHNATHON PATRICK SHAFFER
Active
Individual
JOHNATHON PATRICK SHAFFER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
A167677
CA
2084N0400X
Neurology Physician
Primary
01085483A
IN
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000001581445
ANTHEM PTAN
IN
01
—
090540643
MEDICARE PTAN
IN
05
—
300053899
—
IN
Enumeration date
04/05/2016
Last updated
07/30/2024
Update your record
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