Provider Demographics
NPI:1780650606
Name:SCHAFER, RYAN W (DO)
Entity Type:Individual
Prefix:DR
First Name:RYAN
Middle Name:W
Last Name:SCHAFER
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 1:800 ISABEL ST
Mailing Address - Street 2:
Mailing Address - City:ARDMORE
Mailing Address - State:OK
Mailing Address - Zip Code:73401-5118
Mailing Address - Country:US
Mailing Address - Phone:580-223-5432
Mailing Address - Fax:580-223-6076
Practice Address - Street 1:800 ISABEL ST
Practice Address - Street 2:
Practice Address - City:ARDMORE
Practice Address - State:OK
Practice Address - Zip Code:73401-5118
Practice Address - Country:US
Practice Address - Phone:580-223-5432
Practice Address - Fax:580-223-6076
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-28
Last Update Date:2023-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK4352207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK4352OtherSTATE MEDICAL LICENSE
OK200109030AMedicaid