Provider Demographics
NPI:1114992740
Name:SCHAEFER, JEANNE M (MD)
Entity Type:Individual
Prefix:DR
First Name:JEANNE
Middle Name:M
Last Name:SCHAEFER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:JEANNE
Other - Middle Name:M
Other - Last Name:SCHAEFER-SIMS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 270
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73083-0270
Mailing Address - Country:US
Mailing Address - Phone:405-509-6777
Mailing Address - Fax:405-509-6778
Practice Address - Street 1:523 S SANTA FE AVE STE B
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73003-6291
Practice Address - Country:US
Practice Address - Phone:405-509-6777
Practice Address - Fax:405-509-6778
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-17
Last Update Date:2020-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK18963208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100205560BMedicaid