Provider Demographics
NPI:1437116811
Name:SCHAEFER, DAVID C (MD, PHD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:C
Last Name:SCHAEFER
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2500 N STATE ST
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39216-4500
Mailing Address - Country:US
Mailing Address - Phone:601-984-4540
Mailing Address - Fax:601-984-4548
Practice Address - Street 1:2500 N STATE ST
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39216-4500
Practice Address - Country:US
Practice Address - Phone:601-984-4540
Practice Address - Fax:601-984-4548
Is Sole Proprietor?:No
Enumeration Date:2006-04-28
Last Update Date:2023-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD053148L207RG0100X
MS27262207RG0100X
LA338542207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0015054660006Medicaid
PA0015054660006Medicaid
F98781Medicare UPIN