Healthcare Provider Details

I. General information

NPI: 1174561476
Provider Name (Legal Business Name): BRYON JON SCHAEFFER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/02/2006
Last Update Date: 05/07/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

220 ESSIE DAVISON DR
CLARINDA IA
51632-2915
US

IV. Provider business mailing address

PO BOX 217
CLARINDA IA
51632-0217
US

V. Phone/Fax

Practice location:
  • Phone: 712-542-8330
  • Fax: 712-542-8397
Mailing address:
  • Phone: 712-542-8330
  • Fax: 712-542-8397

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number30681
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: