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General NPI Number Information
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NPI Number | 1629092069
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Entity Type | Organization
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Legal Business Name | DONALD B. SCHAK SR., M.D., PA
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Dates
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Enumeration Date | 07/27/2006
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Last Update Date | 03/13/2013
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Provider Practice Location Address
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Address Line | 120 S JOHN SIMS PKWY SUITE C
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City | VALPARAISO
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State | FL
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Zip | 32580-1212
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Country | US
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Telephone | 850-678-0061
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Fax | 850-678-0068
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Provider Business Mailing Address
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Address Line | 120 S JOHN SIMS PKWY SUITE C
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City | VALPARAISO
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State | FL
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Zip | 32580-1212
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Country | US
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Telephone | 850-678-0061
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Fax | 850-678-0068
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Authorized Official
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Title or Position | DIRECT OWNER
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Name | DR. DONALD B. SCHAK SR.
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Credential | M.D., PA
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Telephone | 850-678-0061
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | ME76306
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License Number State | FL
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