MEDICARE: SHAE MAURA CHAFFIN DO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	K1386	TX

General Provider Information

NPI Number	:	1023264744
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHAE MAURA CHAFFIN DO

Provider Business Mailing Address
First Line	:	9196 SADDLE HORN CT
Second Line	:
City	:	PROSPER
State	:	TX
Zip	:	75078-8829
Country	:	US
Telephone Number	:	972-542-5099
Fax Number	:

Provider Business Practice Location Address
First Line	:	4365 S HULEN ST
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76109-4917
Country	:	US
Telephone Number	:	817-927-4600
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/13/2008
Last Update Date	:	08/13/2008

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