Provider Demographics
NPI:1477885135
Name:SCHAFFER, ROBERT DAVID (IDMT)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:DAVID
Last Name:SCHAFFER
Suffix:
Gender:M
Credentials:IDMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1100 N BROADWAY
Mailing Address - Street 2:206
Mailing Address - City:MINOT
Mailing Address - State:ND
Mailing Address - Zip Code:58703-1332
Mailing Address - Country:US
Mailing Address - Phone:701-723-5133
Mailing Address - Fax:
Practice Address - Street 1:CMR 402 BOX 775
Practice Address - Street 2:
Practice Address - City:APO
Practice Address - State:AE
Practice Address - Zip Code:09180-0775
Practice Address - Country:US
Practice Address - Phone:208-661-1786
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-02-05
Last Update Date:2012-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1003XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Medical Technicians