Healthcare Provider Details

I. General information

NPI: 1447293402
Provider Name (Legal Business Name): DAVID SHAFFER DARR MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/14/2006
Last Update Date: 09/30/2020
Certification Date: 09/30/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1210 PROVIDENT DRIVE STE B
WARSAW IN
46580
US

IV. Provider business mailing address

1210 PROVIDENT DR SUITE A
WARSAW IN
46580-3291
US

V. Phone/Fax

Practice location:
  • Phone: 574-268-4300
  • Fax:
Mailing address:
  • Phone: 574-372-7684
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number01046892A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: