Healthcare Provider Details

I. General information

NPI: 1154535375
Provider Name (Legal Business Name): MARY ALICE SCHAEFER D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/09/2007
Last Update Date: 05/21/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7961 VAN ZYVERDEN RD
MERIDIAN MS
39305-9124
US

IV. Provider business mailing address

7961 VANZYVERDEN RD
MERIDIAN MS
39305
US

V. Phone/Fax

Practice location:
  • Phone: 256-509-0590
  • Fax:
Mailing address:
  • Phone: 256-509-0590
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberDO451
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number340070405
License Number StateOH
# 3
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMS19178
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: