Provider Demographics
NPI:1407145162
Name:SCHAFER, ERIN RENEE (MD)
Entity Type:Individual
Prefix:
First Name:ERIN
Middle Name:RENEE
Last Name:SCHAFER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 FOUNDERS LN
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62650-3919
Mailing Address - Country:US
Mailing Address - Phone:217-243-0300
Mailing Address - Fax:217-245-6775
Practice Address - Street 1:15 FOUNDERS LN
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:IL
Practice Address - Zip Code:62650
Practice Address - Country:US
Practice Address - Phone:217-243-0300
Practice Address - Fax:217-245-6775
Is Sole Proprietor?:No
Enumeration Date:2011-04-04
Last Update Date:2018-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036134904207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036134904OtherMD LICENSES