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General NPI Number Information
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NPI Number | 1609828326
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Entity Type | Individual
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Provider Name | CHARLES SCHAEFFER HERTZ JR. M.D.
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Gender | Male
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Dates
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Enumeration Date | 05/17/2006
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Last Update Date | 07/27/2011
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Provider Practice Location Address
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Address Line | 1691 GALISTEO ST SUITE C
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City | SANTA FE
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State | NM
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Zip | 87505-4780
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Country | US
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Telephone | 505-983-5631
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Fax | 505-982-5605
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Provider Business Mailing Address
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Address Line | 1691 GALISTEO ST SUITE C
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City | SANTA FE
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State | NM
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Zip | 87505-4780
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Country | US
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Telephone | 505-983-5631
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Fax | 505-982-5605
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number | 13380
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License Number State | TN
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Taxonomy #2
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Taxonomy Code | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number | MD2011-0092
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License Number State | NM
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