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General NPI Number Information
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NPI Number | 1477673218
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Entity Type | Individual
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Provider Name | DIANE ELAIN SHAFER M.D.
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Gender | Female
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Dates
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Enumeration Date | 03/29/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 114 W 2ND AVE # 749 114 WEST SECOND AVE.
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City | WILLIAMSON
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State | WV
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Zip | 25661-3104
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Country | US
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Telephone | 304-235-4000
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Fax | 304-235-4249
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Provider Business Mailing Address
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Address Line | PO BOX 749 114 WEST SECOND AVE.
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City | WILLIAMSON
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State | WV
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Zip | 25661-0749
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Country | US
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Telephone | 304-235-4000
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Fax | 304-235-4249
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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 | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | 12440
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License Number State | WV
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