Healthcare Provider Details

I. General information

NPI: 1831190230
Provider Name (Legal Business Name): THOMAS L SCHAEFER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/09/2005
Last Update Date: 03/26/2026
Certification Date: 03/26/2026
Deactivation Date: 03/22/2006
Reactivation Date: 04/11/2006

III. Provider practice location address

3725 RENEE DR
MYRTLE BEACH SC
29579-4109
US

IV. Provider business mailing address

3725 RENEE DR
MYRTLE BEACH SC
29579-4109
US

V. Phone/Fax

Practice location:
  • Phone: 843-350-1124
  • Fax: 877-452-8854
Mailing address:
  • Phone: 843-350-1124
  • Fax: 877-452-8854

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number93521
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License NumberMD032332E
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: