Provider Demographics
NPI:1568405413
Name:SCHAEFER, DONALD P JR (DO)
Entity Type:Individual
Prefix:DR
First Name:DONALD
Middle Name:P
Last Name:SCHAEFER
Suffix:JR
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11330 IRIS RD
Mailing Address - Street 2:
Mailing Address - City:NEOSHO
Mailing Address - State:MO
Mailing Address - Zip Code:64850-7092
Mailing Address - Country:US
Mailing Address - Phone:417-627-2519
Mailing Address - Fax:
Practice Address - Street 1:1333 S SAM HOUSTON BLVD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:MO
Practice Address - Zip Code:65483-2046
Practice Address - Country:US
Practice Address - Phone:417-967-3311
Practice Address - Fax:417-967-1234
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2021-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO106341207Q00000X, 207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100398750DMedicaid
MO26D0446923OtherCLIA
MO245245410Medicaid
OK100183040AMedicaid
KS100398750DMedicaid