Healthcare Provider Details

I. General information

NPI: 1679575930
Provider Name (Legal Business Name): JEFFREY C SHIVERS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/01/2005
Last Update Date: 11/05/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

232 W 25TH ST
ERIE PA
16544-0002
US

IV. Provider business mailing address

PO BOX 49
PITTSBURGH PA
15230-0049
US

V. Phone/Fax

Practice location:
  • Phone: 814-877-2241
  • Fax: 814-456-4542
Mailing address:
  • Phone: 412-937-5949
  • Fax: 412-937-5705

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License NumberMD026655E
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: