Provider Demographics
NPI:1962454223
Name:SCHAEFER, CHRISTINE (DO)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:
Last Name:SCHAEFER
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 1:222 JACKSON AVE
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80521-2445
Mailing Address - Country:US
Mailing Address - Phone:970-495-0267
Mailing Address - Fax:561-209-0323
Practice Address - Street 1:222 JACKSON AVE
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80521-2445
Practice Address - Country:US
Practice Address - Phone:970-495-0267
Practice Address - Fax:561-209-0323
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-16
Last Update Date:2009-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH12247208600000X
CO38684208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO83188266Medicaid
CO83188266Medicaid
COCO305509Medicare PIN