Provider Demographics
NPI:1063653251
Name:SHAFFER, JAMES WILLIAM (PA-C)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:WILLIAM
Last Name:SHAFFER
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 843056
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02284-3056
Mailing Address - Country:US
Mailing Address - Phone:910-878-6700
Mailing Address - Fax:910-878-6705
Practice Address - Street 1:6322 FAYETTEVILLE RD
Practice Address - Street 2:
Practice Address - City:RAEFORD
Practice Address - State:NC
Practice Address - Zip Code:28376-7979
Practice Address - Country:US
Practice Address - Phone:910-878-6700
Practice Address - Fax:910-878-6705
Is Sole Proprietor?:No
Enumeration Date:2009-03-17
Last Update Date:2013-12-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC0010-01674363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical