Healthcare Provider Details

I. General information

NPI: 1114992740
Provider Name (Legal Business Name): JEANNE M SCHAEFER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JEANNE M SCHAEFER-SIMS

II. Dates (important events)

Enumeration Date: 02/17/2006
Last Update Date: 07/17/2020
Certification Date: 07/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

523 S SANTA FE AVE STE B
EDMOND OK
73003-6291
US

IV. Provider business mailing address

PO BOX 270
EDMOND OK
73083-0270
US

V. Phone/Fax

Practice location:
  • Phone: 405-509-6777
  • Fax: 405-509-6778
Mailing address:
  • Phone: 405-509-6777
  • Fax: 405-509-6778

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number18963
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: