Healthcare Provider Details

I. General information

NPI: 1740761519
Provider Name (Legal Business Name): ALEX RENEE SHAFFER PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/28/2018
Last Update Date: 06/05/2026
Certification Date: 06/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1011 COMMERCIAL ST NE
SALEM OR
97301-1049
US

IV. Provider business mailing address

1011 COMMERCIAL ST NE STE 110
SALEM OR
97301-1036
US

V. Phone/Fax

Practice location:
  • Phone: 503-983-9900
  • Fax: 503-983-9899
Mailing address:
  • Phone: 503-983-9900
  • Fax: 503-983-9899

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: