Healthcare Provider Details

I. General information

NPI: 1962666313
Provider Name (Legal Business Name): DONALD SHEFFEL, M.D.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/15/2008
Last Update Date: 07/15/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 RIVER DR
FORT BRAGG CA
95437-5403
US

IV. Provider business mailing address

PO BOX 34120
RENO NV
89533-4120
US

V. Phone/Fax

Practice location:
  • Phone: 707-937-1614
  • Fax:
Mailing address:
  • Phone: 775-747-5050
  • Fax: 775-326-8298

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberC17683
License Number StateCA

VIII. Authorized Official

Name: DONALD SHEFFEL
Title or Position: OWNER
Credential: M.D.
Phone: 707-937-1614