Healthcare Provider Details

I. General information

NPI: 1497806038
Provider Name (Legal Business Name): MR. RON DOUGLAS SCHAFER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/12/2007
Last Update Date: 11/23/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

504 N. CLEVELAND ST.
MOUNT AYR IA
50854-2201
US

IV. Provider business mailing address

504 N. CLEVELAND ST.
MOUNT AYR IA
50854-2201
US

V. Phone/Fax

Practice location:
  • Phone: 641-464-3226
  • Fax: 641-464-4420
Mailing address:
  • Phone: 641-464-3226
  • Fax: 641-464-4420

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number001299
License Number StateIA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier970016501
Identifier TypeMEDICAID
Identifier StateIA
Identifier Issuer
# 2
IdentifierP00277855
Identifier TypeMEDICAID
Identifier StateIA
Identifier Issuer
# 3
Identifier24114
Identifier TypeOTHER
Identifier StateIA
Identifier IssuerBLUE CROSS
# 4
Identifier229098
Identifier TypeOTHER
Identifier StateIA
Identifier IssuerMIDLAND CHOICE
# 5
IdentifierIA0113
Identifier TypeOTHER
Identifier StateIA
Identifier IssuerJOHN DEERE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: