Provider Demographics
NPI:1841293933
Name:SCHAFFER, MARTIN DAVID (MD)
Entity type:Individual
Prefix:
First Name:MARTIN
Middle Name:DAVID
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 1:1912 REALEZA CT
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89102-2061
Mailing Address - Country:US
Mailing Address - Phone:702-221-9132
Mailing Address - Fax:
Practice Address - Street 1:9107 W RUSSELL RD STE 100
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89148-1233
Practice Address - Country:US
Practice Address - Phone:702-221-9132
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-05-23
Last Update Date:2024-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV5637207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV002002329Medicaid
NVC96541Medicare UPIN
NV06WCGXW02Medicare PIN