Provider Demographics
NPI:1396386306
Name:SCHAFF, SAM DAVID I
Entity Type:Individual
Prefix:
First Name:SAM
Middle Name:DAVID
Last Name:SCHAFF
Suffix:I
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3210 OAKRIDGE AVE APT 2110
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79407-1860
Mailing Address - Country:US
Mailing Address - Phone:720-587-9734
Mailing Address - Fax:
Practice Address - Street 1:3210 OAKRIDGE AVE APT 2110
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79407-1860
Practice Address - Country:US
Practice Address - Phone:720-587-9734
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-01
Last Update Date:2019-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer