Mark Johnathan Shaver, M.D.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

MD60167537 Issued in WA

Practice address

720 W Main St
Battle Ground, WA 98604-4406

Phone

(360) 687-6513

NPI assigned

May 22, 2007

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

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": "1179792000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1536883200000",
    "number": "1841409893",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "29212 NE 132ND AVE",
            "city": "BATTLE GROUND",
            "state": "WA",
            "postal_code": "986047576",
            "telephone_number": "541-654-1505"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "720 W MAIN ST",
            "city": "BATTLE GROUND",
            "state": "WA",
            "postal_code": "986044406",
            "telephone_number": "360-687-6513"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2005 W Main St",
            "address_purpose": "LOCATION",
            "city": "Battle Ground",
            "state": "WA",
            "postal_code": "986044311",
            "country_code": "US",
            "telephone_number": "360-882-2778",
            "fax_number": "360-604-1762",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SHAVER",
        "first_name": "MARK",
        "middle_name": "JOHNATHAN",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-05-22",
        "last_updated": "2018-09-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "WA",
            "license": "MD60167537",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "L & I",
            "identifier": "0266346",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Providers in Battle Ground, WA by specialty
• Family Medicine Physician in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 14, 2018; 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.