Healthcare Provider Details

I. General information

NPI: 1790999100
Provider Name (Legal Business Name): CHRISTY SHAFFER RAINEY M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CHRISTY SHAFFER MD

II. Dates (important events)

Enumeration Date: 05/09/2007
Last Update Date: 08/18/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 BUSINESS PARK DR STE C
BRANSON MO
65616-7426
US

IV. Provider business mailing address

3988 HAMMONDS FRY STE C
EVANS GA
30809-8022
US

V. Phone/Fax

Practice location:
  • Phone: 417-239-0125
  • Fax: 417-239-0127
Mailing address:
  • Phone: 210-323-5982
  • Fax: 210-901-9353

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number2007035572
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberM8331
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: