Healthcare Provider Details

I. General information

NPI: 1083694335
Provider Name (Legal Business Name): HEINZ-PETER SCHAFER M. D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/20/2006
Last Update Date: 12/27/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13975 CHURCH ST
WILLISTON SC
29853-5835
US

IV. Provider business mailing address

86 WREN ST
BARNWELL SC
29812-1529
US

V. Phone/Fax

Practice location:
  • Phone: 803-266-0060
  • Fax: 803-266-0042
Mailing address:
  • Phone: 803-259-5762
  • Fax: 803-259-3250

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083P0901X
TaxonomyPublic Health & General Preventive Medicine Physician
License Number24162
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: