Provider Demographics
NPI:1740206622
Name:SCHALLER, SANDERS (MPA, PA-C)
Entity Type:Individual
Prefix:MR
First Name:SANDERS
Middle Name:
Last Name:SCHALLER
Suffix:
Gender:M
Credentials:MPA, PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 N 5TH ST
Mailing Address - Street 2:
Mailing Address - City:HOT SPRINGS
Mailing Address - State:SD
Mailing Address - Zip Code:57747-1480
Mailing Address - Country:US
Mailing Address - Phone:605-891-4962
Mailing Address - Fax:
Practice Address - Street 1:500 N 5TH ST
Practice Address - Street 2:
Practice Address - City:HOT SPRINGS
Practice Address - State:SD
Practice Address - Zip Code:57747-1480
Practice Address - Country:US
Practice Address - Phone:406-731-8888
Practice Address - Fax:406-731-8876
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2024-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD1264363AM0700X
WAPA10004999363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical