Provider Demographics
NPI:1497806038
Name:SCHAFER, RON DOUGLAS
Entity Type:Individual
Prefix:MR
First Name:RON
Middle Name:DOUGLAS
Last Name:SCHAFER
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 1:504 N. CLEVELAND ST.
Mailing Address - Street 2:
Mailing Address - City:MOUNT AYR
Mailing Address - State:IA
Mailing Address - Zip Code:50854-2201
Mailing Address - Country:US
Mailing Address - Phone:641-464-3226
Mailing Address - Fax:641-464-4420
Practice Address - Street 1:504 N. CLEVELAND ST.
Practice Address - Street 2:
Practice Address - City:MOUNT AYR
Practice Address - State:IA
Practice Address - Zip Code:50854-2201
Practice Address - Country:US
Practice Address - Phone:641-464-3226
Practice Address - Fax:641-464-4420
Is Sole Proprietor?:No
Enumeration Date:2007-01-12
Last Update Date:2009-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA001299363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA970016501Medicaid
IAP00277855Medicaid
IA24114OtherBLUE CROSS
IA229098OtherMIDLAND CHOICE
IAIA0113OtherJOHN DEERE
IAP00277855Medicaid
P18250Medicare UPIN
IAI0994Medicare ID - Type Unspecified