Provider Demographics
NPI:1912937574
Name:SCHAEFFER, ALAN R (MD)
Entity Type:Individual
Prefix:DR
First Name:ALAN
Middle Name:R
Last Name:SCHAEFFER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:726 GOODMAN RD E
Mailing Address - Street 2:# B
Mailing Address - City:SOUTHAVEN
Mailing Address - State:MS
Mailing Address - Zip Code:38671-9530
Mailing Address - Country:US
Mailing Address - Phone:662-349-1959
Mailing Address - Fax:662-349-0424
Practice Address - Street 1:726 GOODMAN RD E
Practice Address - Street 2:# B
Practice Address - City:SOUTHAVEN
Practice Address - State:MS
Practice Address - Zip Code:38671-9530
Practice Address - Country:US
Practice Address - Phone:662-349-1959
Practice Address - Fax:662-349-0424
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-03
Last Update Date:2011-08-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MS14992207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS0118823Medicaid
MS0118823Medicaid
A13768Medicare UPIN
MS180000264Medicare PIN
MS0118823Medicaid
MS4245630001Medicare NSC