Provider Demographics
NPI:1316089709
Name:HILLSHAFER, JOHN P (CERTIFIED PEDORTHIST)
Entity type:Individual
Prefix:MR
First Name:JOHN
Middle Name:P
Last Name:HILLSHAFER
Suffix:
Gender:M
Credentials:CERTIFIED PEDORTHIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1250 SHERIDAN AVE
Mailing Address - Street 2:
Mailing Address - City:CODY
Mailing Address - State:WY
Mailing Address - Zip Code:82414-3630
Mailing Address - Country:US
Mailing Address - Phone:307-587-3637
Mailing Address - Fax:
Practice Address - Street 1:1250 SHERIDAN AVE
Practice Address - Street 2:
Practice Address - City:CODY
Practice Address - State:WY
Practice Address - Zip Code:82414-3630
Practice Address - Country:US
Practice Address - Phone:307-587-3637
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY1208120001Medicare ID - Type Unspecified