Provider Demographics
NPI:1407415441
Name:SCHUEPFER, CHARLES JOHN
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:JOHN
Last Name:SCHUEPFER
Suffix:
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 1:78 E MISTYBREEZE CIR
Mailing Address - Street 2:
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77381-3061
Mailing Address - Country:US
Mailing Address - Phone:484-369-1782
Mailing Address - Fax:
Practice Address - Street 1:2001 TIMBERLOCH PL
Practice Address - Street 2:
Practice Address - City:THE WOODLANDS
Practice Address - State:TX
Practice Address - Zip Code:77380-1335
Practice Address - Country:US
Practice Address - Phone:346-298-2933
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-12
Last Update Date:2021-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT84237133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered