Provider Demographics
NPI:1316920549
Name:SHAFER, REED CLIFTON (MD)
Entity type:Individual
Prefix:
First Name:REED
Middle Name:CLIFTON
Last Name:SHAFER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5050 POWDERHOUSE RD
Mailing Address - Street 2:
Mailing Address - City:CHEYENNE
Mailing Address - State:WY
Mailing Address - Zip Code:82009-4800
Mailing Address - Country:US
Mailing Address - Phone:307-634-1311
Mailing Address - Fax:307-634-1271
Practice Address - Street 1:5050 POWDERHOUSE RD
Practice Address - Street 2:
Practice Address - City:CHEYENNE
Practice Address - State:WY
Practice Address - Zip Code:82009-4800
Practice Address - Country:US
Practice Address - Phone:307-634-1311
Practice Address - Fax:307-634-1271
Is Sole Proprietor?:No
Enumeration Date:2005-11-22
Last Update Date:2009-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY2910A2084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY101850700Medicaid
WY2910AOtherSTATE LICENSE
WY511RS92OtherSUBSTANCE CONTROL
301619Medicare ID - Type Unspecified
WY101850700Medicaid