Healthcare Provider Details

I. General information

NPI: 1477885135
Provider Name (Legal Business Name): ROBERT DAVID SCHAFFER IDMT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/05/2010
Last Update Date: 04/26/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CMR 402 BOX 775
APO AE
09180-0775
US

IV. Provider business mailing address

1100 N BROADWAY 206
MINOT ND
58703-1332
US

V. Phone/Fax

Practice location:
  • Phone: 208-661-1786
  • Fax:
Mailing address:
  • Phone: 701-723-5133
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1710I1003X
TaxonomyIndependent Duty Medical Technicians
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: