Provider Demographics
NPI:1740339332
Name:SCHAFERMEYER, KENNETH ERICH (DO)
Entity type:Individual
Prefix:
First Name:KENNETH
Middle Name:ERICH
Last Name:SCHAFERMEYER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2709 INDUSTRIAL DR STE A
Mailing Address - Street 2:
Mailing Address - City:JEFFERSON CITY
Mailing Address - State:MO
Mailing Address - Zip Code:65109-0769
Mailing Address - Country:US
Mailing Address - Phone:573-635-2141
Mailing Address - Fax:573-635-5240
Practice Address - Street 1:2709 INDUSTRIAL DR STE A
Practice Address - Street 2:
Practice Address - City:JEFFERSON CITY
Practice Address - State:MO
Practice Address - Zip Code:65109-0769
Practice Address - Country:US
Practice Address - Phone:573-635-2141
Practice Address - Fax:573-635-5240
Is Sole Proprietor?:No
Enumeration Date:2007-01-10
Last Update Date:2008-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR8652207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
220102500OtherDEPT OF LABOR
080139723OtherRAILROAD PARTNERS
MO240811604Medicaid
A11730OtherPREMIER HEALTH PLAN
431845485OtherPRINCIPAL HEALTH CARE
431845485OtherAMERICAN POSTAL WORKERS
702803OtherHEALTH PARTNERS
0104044OtherUNITED HEALTHCARE
431845485OtherUNITED PAYERS
431845485OtherGENERAL AMERICAN
431845485OtherCIGNA
431845485OtherCENTURY PLANNERS
A11730OtherMERCY HEALTH PLAN
431845485OtherAETNA
MO8988OtherBLUE CROSS
MO116647OtherHEALTH LINK
1703V19251OtherHEALTHCARE USA
58278OtherGROUP HEALTH PLAN
431845485OtherGENERAL AMERICAN
702803OtherHEALTH PARTNERS