Individual
KYLE JOHN SHAVER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1253 NW CANAL BLVD, REDMOND, OR 97756-1334
(541) 548-8131
(541) 460-4028
Mailing address
PO BOX 6095, BEND, OR 97708-6095
(541) 706-5922
(541) 706-6869
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
MD27338
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
055542005
BCBS
—
05
—
057237
—
OR
01
—
56097
WA L & I
—
01
—
930021553
RAILROAD
—
01
—
C98636
PROVIDENCE
—
Enumeration date
11/14/2006
Last updated
12/04/2023
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