Provider Demographics
NPI:1225605785
Name:SHAFER, JONATHAN M (DO)
Entity type:Individual
Prefix:
First Name:JONATHAN
Middle Name:M
Last Name:SHAFER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:DR
Other - First Name:JONATHAN
Other - Middle Name:
Other - Last Name:SHAFER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DO
Mailing Address - Street 1:640 KOLTER DR
Mailing Address - Street 2:
Mailing Address - City:INDIANA
Mailing Address - State:PA
Mailing Address - Zip Code:15701-3570
Mailing Address - Country:US
Mailing Address - Phone:724-835-7171
Mailing Address - Fax:724-357-7279
Practice Address - Street 1:879 HOSPITAL RD
Practice Address - Street 2:
Practice Address - City:INDIANA
Practice Address - State:PA
Practice Address - Zip Code:15701-3629
Practice Address - Country:US
Practice Address - Phone:888-845-2147
Practice Address - Fax:724-357-8202
Is Sole Proprietor?:No
Enumeration Date:2021-06-04
Last Update Date:2024-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOT020606207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine