Healthcare Provider Details

I. General information

NPI: 1497743918
Provider Name (Legal Business Name): JOHN LESTER SCHAEFFER D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/10/2005
Last Update Date: 05/04/2020
Certification Date: 05/04/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 CALIFORNIA ST STE 2710
SAN FRANCISCO CA
94111-5818
US

IV. Provider business mailing address

101 CALIFORNIA ST STE 2710
SAN FRANCISCO CA
94111-5818
US

V. Phone/Fax

Practice location:
  • Phone: 916-320-4222
  • Fax: 888-370-2829
Mailing address:
  • Phone: 916-320-4222
  • Fax: 888-370-2829

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0805X
TaxonomyGeriatric Psychiatry Physician
License Number20A9536
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code2084P0805X
TaxonomyGeriatric Psychiatry Physician
License Number38750
License Number StateCO
# 3
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberA-1243-03
License Number StateNM
# 4
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number38750
License Number StateCO
# 5
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number20A9536
License Number StateCA
# 6
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number38750
License Number StateCO
# 7
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License NumberA-1243-03
License Number StateNM
# 8
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number20A9536
License Number StateCA
# 9
Primary TaxonomyN
Taxonomy Code2084P0805X
TaxonomyGeriatric Psychiatry Physician
License NumberA-1243-03
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: