Provider Demographics
NPI:1639117203
Name:SHARON K SCHAEFER MD INC
Entity Type:Organization
Organization Name:SHARON K SCHAEFER MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:K
Authorized Official - Last Name:SCHAEFER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:907-746-6100
Mailing Address - Street 1:2490 S WOODWORTH LOOP
Mailing Address - Street 2:SUITE 300
Mailing Address - City:PALMER
Mailing Address - State:AK
Mailing Address - Zip Code:99645-7405
Mailing Address - Country:US
Mailing Address - Phone:907-746-6100
Mailing Address - Fax:907-746-6138
Practice Address - Street 1:2490 S WOODWORTH LOOP
Practice Address - Street 2:SUITE 300
Practice Address - City:PALMER
Practice Address - State:AK
Practice Address - Zip Code:99645-7405
Practice Address - Country:US
Practice Address - Phone:907-746-6100
Practice Address - Fax:907-746-6138
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-03
Last Update Date:2010-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK3722208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK5792Medicaid
AKG16148Medicare UPIN
AK160652Medicare ID - Type Unspecified