Healthcare Provider Details

I. General information

NPI: 1770536872
Provider Name (Legal Business Name): JOHN D SCHAEFFER D.O
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/18/2006
Last Update Date: 03/31/2021
Certification Date: 03/31/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 N ORANGE ST THIRD FLOOR
MISSOULA MT
59802-2998
US

IV. Provider business mailing address

900 N ORANGE ST THIRD FLOOR
MISSOULA MT
59802-2998
US

V. Phone/Fax

Practice location:
  • Phone: 406-327-3379
  • Fax: 406-327-3355
Mailing address:
  • Phone: 406-327-3379
  • Fax: 406-327-3355

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number11080
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: