Provider Demographics
NPI:1831163674
Name:SCHAFER, CORA YVONNE (PA)
Entity type:Individual
Prefix:
First Name:CORA
Middle Name:YVONNE
Last Name:SCHAFER
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:CORA
Other - Middle Name:
Other - Last Name:HADDOX
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:401 HOSPITAL DR
Mailing Address - Street 2:SUITE 120
Mailing Address - City:CORSICANA
Mailing Address - State:TX
Mailing Address - Zip Code:75110-2415
Mailing Address - Country:US
Mailing Address - Phone:903-872-3005
Mailing Address - Fax:903-872-3050
Practice Address - Street 1:401 HOSPITAL DR
Practice Address - Street 2:SUITE 140
Practice Address - City:CORSICANA
Practice Address - State:TX
Practice Address - Zip Code:75110-2415
Practice Address - Country:US
Practice Address - Phone:903-872-3005
Practice Address - Fax:903-875-7229
Is Sole Proprietor?:No
Enumeration Date:2006-02-16
Last Update Date:2012-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA00095363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX189751401Medicaid
TXDG9311OtherRAILROAD MEDICARE GROUP
TX00Y226OtherMEDICARE GROUP
TXP00463089OtherRAILROAD MEDICARE
S09775Medicare UPIN
TX8F6255Medicare PIN