Provider Demographics
NPI:1821523127
Name:SCHAEFER, CLINTON JAMES
Entity Type:Individual
Prefix:
First Name:CLINTON
Middle Name:JAMES
Last Name:SCHAEFER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40942 SANDNER DR
Mailing Address - Street 2:
Mailing Address - City:SCIO
Mailing Address - State:OR
Mailing Address - Zip Code:97374-9564
Mailing Address - Country:US
Mailing Address - Phone:503-939-0746
Mailing Address - Fax:
Practice Address - Street 1:40942 SANDNER DR
Practice Address - Street 2:
Practice Address - City:SCIO
Practice Address - State:OR
Practice Address - Zip Code:97374-9564
Practice Address - Country:US
Practice Address - Phone:503-939-0746
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-24
Last Update Date:2017-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program