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General NPI Number Information
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NPI Number | 1336179969
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Entity Type | Individual
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Provider Name | JONATHAN DANIEL SHOFFNER MD
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Gender | Male
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Dates
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Enumeration Date | 07/03/2006
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Last Update Date | 01/23/2012
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Provider Practice Location Address
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Address Line | 1001 CRESCENT GREEN
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City | CARY
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State | NC
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Zip | 27511
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Country | US
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Telephone | 919-467-3211
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Fax | 919-467-5315
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Provider Business Mailing Address
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Address Line | 1001 CRESCENT GRN
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City | CARY
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State | NC
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Zip | 27518-8101
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Country | US
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Telephone | 919-235-3042
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Fax | 919-235-3094
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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 | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 200100462
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License Number State | NC
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Legacy Identifiers
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Identifier #1
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Identifier Code | 89128V6
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Identifier Type | MEDICAID
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Identifier State | NC
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Identifier Issuer |
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Proprietary Identifiers Ever Reported
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Identifier #1
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Identifier Code | 89128V6
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Identifier Type | MEDICAID
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Identifier State | NC
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Identifier Issuer |
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