Provider Demographics
NPI:1801900857
Name:SUZANNE SCHAFER, DO, PA
Entity type:Organization
Organization Name:SUZANNE SCHAFER, DO, PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SUZANNE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:SCHAFER
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:409-908-9555
Mailing Address - Street 1:6807 EMMETT F LOWRY EXPY
Mailing Address - Street 2:SUITE 310
Mailing Address - City:TEXAS CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77591-2546
Mailing Address - Country:US
Mailing Address - Phone:409-908-9555
Mailing Address - Fax:409-908-9556
Practice Address - Street 1:6807 EMMETT F LOWRY EXPY
Practice Address - Street 2:SUITE 310
Practice Address - City:TEXAS CITY
Practice Address - State:TX
Practice Address - Zip Code:77591-2546
Practice Address - Country:US
Practice Address - Phone:409-908-9555
Practice Address - Fax:409-908-9556
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-18
Last Update Date:2008-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH0790207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0037NSOtherBCBS
TX0037NSOtherBCBS
TX00X065Medicare PIN