Provider Demographics
NPI:1477525509
Name:SCHOFFERMAN, JEROME A (MD)
Entity Type:Individual
Prefix:
First Name:JEROME
Middle Name:A
Last Name:SCHOFFERMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1850 SULLIVAN AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:DALY CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94015-2221
Mailing Address - Country:US
Mailing Address - Phone:650-985-7500
Mailing Address - Fax:650-985-7511
Practice Address - Street 1:1850 SULLIVAN AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:DALY CITY
Practice Address - State:CA
Practice Address - Zip Code:94015-2221
Practice Address - Country:US
Practice Address - Phone:650-985-7500
Practice Address - Fax:650-985-7511
Is Sole Proprietor?:No
Enumeration Date:2006-02-02
Last Update Date:2011-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG21414208VP0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAP00066665OtherMEDICARE RAILORAD PIN
CA00G214140Medicare ID - Type UnspecifiedMEDICARE PPIN
CAA41279Medicare UPIN