| Doctor Name: | MARK JOHNATHAN SHAVER |
| NPI Number: | 1841409893 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | M.D. |
| License Number: | MD26051 |
| Business Practice Address: | 2005 W Main St Battle Ground, WA - 986044311 |
| Business Phone Number: | 3608822778 |
| Business Fax Number: | 3606041762 |
| Mailing Address: | 700 Ne 87th Ave, VANCOUVER |
| State: | WA |
| Postal Code: | 986641913 |
| Phone Number: | 3608822778 |
| Fax Number: | 3606041762 |
| NPI Enumeration Date: | 05/22/2007 |
| NPI Last Update Date: | 12/27/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | MD26051 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | OR |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |