Individual
MORTEZA SHAFA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
245 BROADWAY ST., LA CENTER, KY 42056
(270) 665-9195
(270) 665-5420
Mailing address
PO BOX 180, LA CENTER, KY 42056-0180
(270) 665-9195
(270) 665-5420
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
22367
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
64223670
—
KY
Enumeration date
07/11/2006
Last updated
07/08/2007
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