=====================================================
General NPI Number Information
=====================================================
NPI Number | 1891797536
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ROBERT INGO SHAFFER M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/12/2005
-----------------------------------------------------
Last Update Date | 02/04/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4302 ALTON RD SUITE 300
-----------------------------------------------------
City | MIAMI BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33140-2891
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-672-9989
-----------------------------------------------------
Fax | 786-245-2006
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3640 YACHT CLUB DR APT 104
-----------------------------------------------------
City | AVENTURA
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33180-3558
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 786-942-6921
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number | ME0064953
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------