Provider Demographics
NPI:1023192812
Name:SCHAFER, LARRY A (MD)
Entity Type:Individual
Prefix:
First Name:LARRY
Middle Name:A
Last Name:SCHAFER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2480 W 26TH AVE
Mailing Address - Street 2:SUITE 200B
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80211-5326
Mailing Address - Country:US
Mailing Address - Phone:303-467-4161
Mailing Address - Fax:303-467-4156
Practice Address - Street 1:3655 LUTHERAN PKWY
Practice Address - Street 2:SUITE 406
Practice Address - City:WHEAT RIDGE
Practice Address - State:CO
Practice Address - Zip Code:80033-6018
Practice Address - Country:US
Practice Address - Phone:303-403-7333
Practice Address - Fax:303-403-7335
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2008-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO16025207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01160258Medicaid
CO80241Medicare ID - Type Unspecified
CO01160258Medicaid
COC809325Medicare PIN