Healthcare Provider Details

I. General information

NPI: 1992705206
Provider Name (Legal Business Name): WILLIAM H SHAFER JR. MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/28/2005
Last Update Date: 04/01/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5875 BREMO RD SUITE 204
RICHMOND VA
23226-1934
US

IV. Provider business mailing address

5875 BREMO RD SUITE 204
RICHMOND VA
23226-1934
US

V. Phone/Fax

Practice location:
  • Phone: 804-977-8915
  • Fax: 804-288-1326
Mailing address:
  • Phone: 804-977-8915
  • Fax: 804-288-1326

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number0101032098
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: