Healthcare Provider Details

I. General information

NPI: 1700834603
Provider Name (Legal Business Name): GEORGE VALENTINE SCHAEFER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/04/2006
Last Update Date: 09/24/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3101 SE 14TH ST
BENTONVILLE AR
72712-4900
US

IV. Provider business mailing address

3101 SE 14TH ST
BENTONVILLE AR
72712-4900
US

V. Phone/Fax

Practice location:
  • Phone: 479-636-9234
  • Fax: 479-636-0774
Mailing address:
  • Phone: 479-636-9234
  • Fax: 479-636-0774

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License NumberC7531
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: