MEDICARE: DENISE LORRAINE SHAFF MD

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	F4513	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	F4513	OTHER	TX	LICENCE

General Provider Information

NPI Number	:	1801837737
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DENISE LORRAINE SHAFF MD

Provider Business Mailing Address
First Line	:	5711 LONGMONT LN
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77057-2509
Country	:	US
Telephone Number	:	832-477-1505
Fax Number	:	713-785-1557

Provider Business Practice Location Address
First Line	:	5711 LONGMONT LN
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77057-2509
Country	:	US
Telephone Number	:	832-477-1505
Fax Number	:	713-785-1557

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

Provider Enumeration Date	:	06/10/2006
Last Update Date	:	04/01/2008

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