Provider Demographics
NPI:1558415083
Name:SCHAFER, DAVID A (MD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:A
Last Name:SCHAFER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:DAVID
Other - Middle Name:A
Other - Last Name:SCHAFER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:5005 PORT ST JOHN PKWY STE 2200
Mailing Address - Street 2:
Mailing Address - City:PORT ST JOHN
Mailing Address - State:FL
Mailing Address - Zip Code:32927-4305
Mailing Address - Country:US
Mailing Address - Phone:321-433-2247
Mailing Address - Fax:847-634-2900
Practice Address - Street 1:5005 PORT ST JOHN PKWY STE 2200
Practice Address - Street 2:
Practice Address - City:PORT ST JOHN
Practice Address - State:FL
Practice Address - Zip Code:32927-4305
Practice Address - Country:US
Practice Address - Phone:321-433-2247
Practice Address - Fax:847-634-2900
Is Sole Proprietor?:No
Enumeration Date:2007-01-22
Last Update Date:2024-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036112063207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036112603Medicaid
K20394Medicare ID - Type Unspecified
IL036112603Medicaid
IL212203Medicare PIN
IL212204Medicare PIN