Provider Demographics
NPI:1992722516
Name:SHAFFER, HOWARD L (MD)
Entity type:Individual
Prefix:
First Name:HOWARD
Middle Name:L
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:PO BOX 961205
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76161-1205
Mailing Address - Country:US
Mailing Address - Phone:817-740-8400
Mailing Address - Fax:817-570-0174
Practice Address - Street 1:6100 HARRIS PKWY
Practice Address - Street 2:STE 350
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76132-4134
Practice Address - Country:US
Practice Address - Phone:817-433-5350
Practice Address - Fax:817-570-0174
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2011-09-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXE1127207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX099439403Medicaid
040017811OtherRAILROAD MEDICARE
040017811OtherRAILROAD MEDICARE
TX099439403Medicaid