Provider Demographics
NPI:1972577880
Name:SCHAFER, LARRY WILLIAM (MD)
Entity Type:Individual
Prefix:
First Name:LARRY
Middle Name:WILLIAM
Last Name:SCHAFER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2400 S. MINNESOTA AVE.
Mailing Address - Street 2:STE. 100
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57105-3762
Mailing Address - Country:US
Mailing Address - Phone:605-322-7510
Mailing Address - Fax:605-322-6475
Practice Address - Street 1:1417 S. CLIFF AVE.
Practice Address - Street 2:STE. 300
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57105-1062
Practice Address - Country:US
Practice Address - Phone:605-322-8630
Practice Address - Fax:605-322-8631
Is Sole Proprietor?:No
Enumeration Date:2006-02-15
Last Update Date:2014-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD1541207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD0040344OtherBLUE CROSS
SD10662OtherMIDLANDS CHOICE
SD1541OtherDAKOTACARE
SD57105B004OtherWPS TRICARE
SD20854OtherSANFORD HEALTH PLAN
MN127106OtherUCARE
MN479075800Medicaid
SD6001292Medicaid
SDHP24767OtherHEALTHPARTNERS
SD100016415OtherRR MEDICARE
SD2900243OtherMEDICA
MN125M9SCOtherBLUE CROSS
MN125M9SCOtherCC SYSTEMS/ BLUE PLUS
SD22863OtherARAZ/ AMERICA'S PPO
CAXPY205856Medicaid
IA1913624Medicaid
NE46022474338Medicaid
SD769171028152OtherPREFERRED ONE
SD22863OtherARAZ/ AMERICA'S PPO
SD6001292Medicaid