Individual
DR. THOMAS RAUBY SHAFFER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PH.D.
Contact information
Practice address
1310 MAIN AVE S, SUITE 9, BROOKINGS, SD 57006-3819
(605) 692-6367
(605) 692-1883
Mailing address
PO BOX 931, BROOKINGS, SD 57006-0931
(605) 695-0651
(605) 692-1883
Taxonomy
Speciality
Code
Description
License number
State
103G00000X
Clinical Neuropsychologist
Primary
472
SD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
6552660
—
SD
01
—
S102729
MEDICARE PTAN/ID
—
Enumeration date
08/01/2008
Last updated
07/14/2014
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