Provider Demographics
NPI:1306850284
Name:SCHAK, DONALD B SR (MD, PA)
Entity Type:Individual
Prefix:DR
First Name:DONALD
Middle Name:B
Last Name:SCHAK
Suffix:SR
Gender:M
Credentials:MD, PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:120 S JOHN SIMS PKWY
Mailing Address - Street 2:SUITE C
Mailing Address - City:VALPARAISO
Mailing Address - State:FL
Mailing Address - Zip Code:32580-1212
Mailing Address - Country:US
Mailing Address - Phone:850-678-0061
Mailing Address - Fax:850-678-0068
Practice Address - Street 1:120 S JOHN SIMS PKWY
Practice Address - Street 2:SUITE C
Practice Address - City:VALPARAISO
Practice Address - State:FL
Practice Address - Zip Code:32580-1212
Practice Address - Country:US
Practice Address - Phone:850-678-0061
Practice Address - Fax:850-678-0068
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-28
Last Update Date:2013-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME76306207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL44534OtherBCBS
FLB288OtherHEALTH OPTIONS
FL256492100Medicaid
FLB288OtherHEALTH OPTIONS
FLE0978Medicare PIN