Provider Demographics
NPI:1487620167
Name:SHAFFER, MATTHEW P (MD)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:P
Last Name:SHAFFER
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 1:9300 E 29TH ST N STE 310
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67226-2160
Mailing Address - Country:US
Mailing Address - Phone:316-612-1833
Mailing Address - Fax:316-612-2420
Practice Address - Street 1:828 ELMHURST BLVD
Practice Address - Street 2:
Practice Address - City:SALINA
Practice Address - State:KS
Practice Address - Zip Code:67401-7406
Practice Address - Country:US
Practice Address - Phone:785-827-2500
Practice Address - Fax:785-827-2515
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-23
Last Update Date:2025-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04-29936207N00000X
KS0429936207ND0101X, 207ND0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic SurgeryGroup - Single Specialty
No207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS623450OtherFIRST GUARD
KS103734OtherBCBS (HAYS LOCATION)
KSP00154203OtherTRAVELERS MEDICARE
KS103745OtherBCBS (SALINA LOCATION)
KS103735OtherBCBS (GREAT BEND LOCATION
KS103734Medicare ID - Type UnspecifiedHAYS LOCATION
KS623450OtherFIRST GUARD
KS103745Medicare ID - Type UnspecifiedSALINA LOCATION