=====================================================
General NPI Number Information
=====================================================
NPI Number | 1376645267
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JAMES ROLAND SCHAEFER MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/02/2006
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8851 CENTER DR SUITE 210
-----------------------------------------------------
City | LA MESA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91942-3045
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 619-463-3363
-----------------------------------------------------
Fax | 619-463-4181
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8851 CENTER DR SUITE 210
-----------------------------------------------------
City | LA MESA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91942-3045
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 619-463-3363
-----------------------------------------------------
Fax | 619-463-4181
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207VX0000X
-----------------------------------------------------
Taxonomy Name | Obstetrics Physician
-----------------------------------------------------
License Number | A40008
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------