Provider Demographics
NPI:1154315448
Name:SCHOFFLER, JEROME C (DPM)
Entity Type:Individual
Prefix:DR
First Name:JEROME
Middle Name:C
Last Name:SCHOFFLER
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2608 HARWOOD RD
Mailing Address - Street 2:
Mailing Address - City:BEDFORD
Mailing Address - State:TX
Mailing Address - Zip Code:76021-3700
Mailing Address - Country:US
Mailing Address - Phone:817-283-7288
Mailing Address - Fax:817-283-7311
Practice Address - Street 1:2906 HIGHGROVE CT
Practice Address - Street 2:
Practice Address - City:COLLEYVILLE
Practice Address - State:TX
Practice Address - Zip Code:76034
Practice Address - Country:US
Practice Address - Phone:817-832-1182
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-01
Last Update Date:2018-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX0793213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX480002499OtherPALMETTO GBA
TX87Z921Medicare ID - Type Unspecified
TX480002499OtherPALMETTO GBA
TXT15774Medicare UPIN
TXTXB106241Medicare PIN