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General NPI Number Information
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NPI Number | 1104359561
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Entity Type | Individual
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Provider Name | ANDREW B. SHAFFER
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Gender | Male
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Dates
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Enumeration Date | 04/04/2017
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Last Update Date | 09/06/2022
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Provider Practice Location Address
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Address Line | 2600 NE NEFF RD
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City | BEND
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State | OR
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Zip | 97701-6337
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Country | US
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Telephone | 541-706-7735
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Fax | 541-706-4806
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Provider Business Mailing Address
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Address Line | 9964 S 610 E
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City | SANDY
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State | UT
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Zip | 84070-3810
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Country | US
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Telephone | 703-400-8757
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RR0500X
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Taxonomy Name | Rheumatology Physician
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License Number | 11749246-1205
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License Number State | UT
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