Provider Demographics
NPI:1659394898
Name:SCHEFFEL, TIM W (DO)
Entity Type:Individual
Prefix:
First Name:TIM
Middle Name:W
Last Name:SCHEFFEL
Suffix:
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 1:3179 LAKE ST
Mailing Address - Street 2:
Mailing Address - City:HOMER
Mailing Address - State:AK
Mailing Address - Zip Code:99603-7908
Mailing Address - Country:US
Mailing Address - Phone:907-299-6069
Mailing Address - Fax:888-639-5730
Practice Address - Street 1:3179 LAKE ST
Practice Address - Street 2:
Practice Address - City:HOMER
Practice Address - State:AK
Practice Address - Zip Code:99603-7908
Practice Address - Country:US
Practice Address - Phone:907-299-6069
Practice Address - Fax:888-639-5730
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2014-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AKAK2737207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKMD27374Medicaid
AKE33028Medicare UPIN
AKMD27374Medicaid