Blake Richard Shaffer, MD

Primary specialty

Student in an Organized Health Care Education/Training ProgramTaxonomy code 390200000X

License

0101261224 Issued in VA

Practice address

307 Boatner Rd Ste 114
Eglin AFB, FL 32542-1302

Phone

(850) 883-8600

NPI assigned

Jun 16, 2015

Last updated

Jun 5, 2020By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1434412800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1591315200000",
    "number": "1235510140",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "307 BOATNER RD STE 114",
            "city": "EGLIN AFB",
            "state": "FL",
            "postal_code": "325421302"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "307 BOATNER RD STE 114",
            "city": "EGLIN AFB",
            "state": "FL",
            "postal_code": "325421302",
            "telephone_number": "850-883-8600"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHAFFER",
        "first_name": "BLAKE",
        "middle_name": "RICHARD",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2015-06-16",
        "last_updated": "2020-06-05",
        "certification_date": "2020-06-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "VA",
            "license": "0101261224",
            "primary": true
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "PA",
            "license": "MT208977",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Corrie Secord, CNM
• Debra Sjohn Secrest, OCCUPATIONAL THERAPI
• Edward Herman Seeliger Jr., MD
• Crescent Seibert
• Emily Sexton, DDS
• Kyra Y Shea, D.M.D.
• Brian Robert Sheakoski, PHARM. D.
• Alice Lyn Shepard, PNP-BC
• Amelia Lane Sheppard, MD
• Patrick Leonard Short, M.D.

• Student in an Organized Health Care Education/Training Program in Eglin AFB, FL
• Providers in Eglin AFB, FL by specialty
• Student in an Organized Health Care Education/Training Program in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 5, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.