Provider Demographics
NPI:1750364931
Name:SCHAFFER, SCOTT J (MD)
Entity type:Individual
Prefix:
First Name:SCOTT
Middle Name:J
Last Name:SCHAFFER
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 1:1627 E 18TH ST
Mailing Address - Street 2:
Mailing Address - City:LOVELAND
Mailing Address - State:CO
Mailing Address - Zip Code:80538-4209
Mailing Address - Country:US
Mailing Address - Phone:970-663-0135
Mailing Address - Fax:970-461-1422
Practice Address - Street 1:303 COLLAND DR
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80525-4205
Practice Address - Country:US
Practice Address - Phone:970-461-8031
Practice Address - Fax:970-461-8932
Is Sole Proprietor?:No
Enumeration Date:2005-11-22
Last Update Date:2011-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO30781207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01307818Medicaid
COSCT6228OtherANTHEM BCBS
COSCT6228OtherANTHEM BCBS
CO01307818Medicaid
COSCT6228OtherANTHEM BCBS
COC552358Medicare PIN