Provider Demographics
NPI:1952372336
Name:SCHAFER, DOUGLAS C (PA)
Entity Type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:C
Last Name:SCHAFER
Suffix:
Gender:M
Credentials:PA
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 900
Mailing Address - Street 2:
Mailing Address - City:FREEMAN
Mailing Address - State:SD
Mailing Address - Zip Code:57029-0900
Mailing Address - Country:US
Mailing Address - Phone:605-925-4219
Mailing Address - Fax:
Practice Address - Street 1:804 S WALNUT ST
Practice Address - Street 2:
Practice Address - City:FREEMAN
Practice Address - State:SD
Practice Address - Zip Code:57029-0900
Practice Address - Country:US
Practice Address - Phone:605-925-4219
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-01
Last Update Date:2010-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD0171363A00000X
363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD6820372Medicaid
SD6820370Medicaid
SDS41404Medicare ID - Type Unspecified
SDS41384Medicare ID - Type Unspecified
SD6820370Medicaid