Healthcare Provider Details

I. General information

NPI: 1851663280
Provider Name (Legal Business Name): GONZALEZ & SCHEFFER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/01/2012
Last Update Date: 02/01/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 RUSSELL ST
HAYTI MO
63851-1300
US

IV. Provider business mailing address

PO BOX 544
HAYTI MO
63851-0544
US

V. Phone/Fax

Practice location:
  • Phone: 573-359-2930
  • Fax: 573-359-1304
Mailing address:
  • Phone: 573-359-2930
  • Fax: 573-359-1304

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: ARIEL GONZALEZ
Title or Position: PARTNER
Credential: MD
Phone: 812-675-7616