Provider Demographics
NPI:1497920540
Name:SCHAFER, JAMES ROBERT ALAN (MD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:ROBERT ALAN
Last Name:SCHAFER
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:PO BOX 42456
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45242-0456
Mailing Address - Country:US
Mailing Address - Phone:513-247-8646
Mailing Address - Fax:513-965-8091
Practice Address - Street 1:375 DIXMYTH AVE
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45220-2475
Practice Address - Country:US
Practice Address - Phone:513-862-2611
Practice Address - Fax:513-965-8091
Is Sole Proprietor?:No
Enumeration Date:2008-04-29
Last Update Date:2014-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI43010916472085R0202X
OH35-1210212085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0075529Medicaid
IN201181930Medicaid
KY7100244340Medicaid
OH0075529Medicaid
IN201181930Medicaid