Provider Demographics
NPI:1023039435
Name:SCHAFFER, ROBERT RANDALL (MD, FAAFP)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:RANDALL
Last Name:SCHAFFER
Suffix:
Gender:M
Credentials:MD, FAAFP
Other - Prefix:
Other - First Name:R
Other - Middle Name:RANDALL
Other - Last Name:SCHAFFER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD, FAAFP
Mailing Address - Street 1:420 N JAMES RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43219-1834
Mailing Address - Country:US
Mailing Address - Phone:614-257-5800
Mailing Address - Fax:614-257-5801
Practice Address - Street 1:4100 W 3RD ST
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45428-9000
Practice Address - Country:US
Practice Address - Phone:937-268-6511
Practice Address - Fax:513-423-3309
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2017-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME91795207Q00000X
MT6192207Q00000X
OH35056157207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHE33410Medicare UPIN
OHSC0632581Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER
OHE33410Medicare UPIN
OH0739179Medicaid
OHSC0632581Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER