Healthcare Provider Details

I. General information

NPI: 1629092069
Provider Name (Legal Business Name): DONALD B. SCHAK SR., M.D., PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/27/2006
Last Update Date: 03/13/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 S JOHN SIMS PKWY SUITE C
VALPARAISO FL
32580-1212
US

IV. Provider business mailing address

120 S JOHN SIMS PKWY SUITE C
VALPARAISO FL
32580-1212
US

V. Phone/Fax

Practice location:
  • Phone: 850-678-0061
  • Fax: 850-678-0068
Mailing address:
  • Phone: 850-678-0061
  • Fax: 850-678-0068

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberME76306
License Number StateFL

VIII. Authorized Official

Name: DR. DONALD B. SCHAK SR.
Title or Position: DIRECT OWNER
Credential: M.D., PA
Phone: 850-678-0061