Provider Demographics
NPI:1841284007
Name:SCHAFER, SUZANNE MARIE (DO)
Entity type:Individual
Prefix:
First Name:SUZANNE
Middle Name:MARIE
Last Name:SCHAFER
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1383
Mailing Address - Street 2:
Mailing Address - City:LA PORTE
Mailing Address - State:TX
Mailing Address - Zip Code:77572-1383
Mailing Address - Country:US
Mailing Address - Phone:281-703-6618
Mailing Address - Fax:713-482-4560
Practice Address - Street 1:1005 S. BROADWAY ST.
Practice Address - Street 2:
Practice Address - City:LA PORTE
Practice Address - State:TX
Practice Address - Zip Code:77571
Practice Address - Country:US
Practice Address - Phone:281-470-8770
Practice Address - Fax:281-470-0313
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-02
Last Update Date:2021-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH0790207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX114090706Medicaid
TX114090706Medicaid
TXP00741703Medicare PIN
TX8F9585Medicare PIN
TX8F4012Medicare PIN