Elaine L. Shafer, M.D.
Individual provider Active NPI Family Medicine Physician · Bristol, IN
NPI 1730188707 · NPPES record last updated Mar 28, 2008
Key facts
- NPI
- 1730188707
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Medicine Physician 207Q00000X
- License
- 01042902A (IN)
- Practice address
- 306 E Vistula St
Bristol, IN 46507-9489 - Phone
- (574) 848-4427
- Fax
- (574) 848-4592
- NPI assigned
- Jul 20, 2005
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 01042902A | IN | MD | Family Medicine Physician |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 01042902A | IN | Yes |
Addresses
Primary practice location
306 E Vistula St
Bristol, IN 46507-9489
Mailing address
306 E Vistula St
Bristol, IN 46507-9489
Phone (574) 848-4427
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 000000109333 | Other | IN | ANTHEM BCBS # - FPA |
| 000000313699 | Other | IN | ANTHEM BCBS # - FMC |
| 000000109332 | Other | IN | ANTHEM BCBS # - BFP |
| HPM 39695 | Medicaid | MI | |
| 000000536675 | Other | IN | ANTHEM BCBS # - OSC |
Other providers in Bristol, IN
- Kimberley Lynne Landman
- Local Health Indiana Inc.
- Tamara L Pinto
- Regional Home Health Care Inc
- Senior Mobility Incorporated
- Brenda H. Spence
- Denise Ann Ward
- Katrina A Yoder
All providers in Bristol, IN · Family Medicine Physician in Indiana
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 28, 2008. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.