Provider Demographics
NPI:1407895253
Name:SCHAEFER, DALE GLENN (MD)
Entity Type:Individual
Prefix:
First Name:DALE
Middle Name:GLENN
Last Name:SCHAEFER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:3807 SPICEWOOD SPRINGS RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78759-8965
Mailing Address - Country:US
Mailing Address - Phone:512-476-9195
Mailing Address - Fax:512-476-2857
Practice Address - Street 1:3807 SPICEWOOD SPRINGS RD
Practice Address - Street 2:SUITE 200
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78759-8965
Practice Address - Country:US
Practice Address - Phone:512-476-9195
Practice Address - Fax:512-476-2857
Is Sole Proprietor?:No
Enumeration Date:2006-06-06
Last Update Date:2017-08-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXG7450207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8A3573Medicare ID - Type UnspecifiedBILLING NUMBER
TXB88012Medicare UPIN
TX00486UOtherMEDICARE GROUP BILLING ID
TXCK3641OtherRR MEDICARE GROUP ID
TX0021HWOtherBCBS GROUP BILLING ID
TX1245417294OtherGROUP NPI
TXB88012Medicare UPIN