Provider Demographics
NPI:1922097799
Name:BADGER, MARY SCHAEFER (DO)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:SCHAEFER
Last Name:BADGER
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6002 N LIDGERWOOD ST
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99208-1124
Mailing Address - Country:US
Mailing Address - Phone:509-482-4402
Mailing Address - Fax:
Practice Address - Street 1:6002 N LIDGERWOOD ST
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99208-1124
Practice Address - Country:US
Practice Address - Phone:509-482-4402
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-10-14
Last Update Date:2021-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOP00001225207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8130917Medicaid
000010002941OtherBC OF IDAHO
WA8130197Medicaid
000010002941OtherBC OF IDAHO
E34737OtherASURIS