MEDICARE: DR. RANDALL L. SCHAFFNER M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	J0242	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1962400895
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RANDALL L. SCHAFFNER M.D.

Provider Business Mailing Address
First Line	:	4301 COLLEGE DR
Second Line	:	SUITE # 300
City	:	VERNON
State	:	TX
Zip	:	76384-3128
Country	:	US
Telephone Number	:	940-552-0552
Fax Number	:	940-552-0559

Provider Business Practice Location Address
First Line	:	4301 COLLEGE DR
Second Line	:	SUITE # 300
City	:	VERNON
State	:	TX
Zip	:	76384-3128
Country	:	US
Telephone Number	:	940-552-0552
Fax Number	:	940-552-0559

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/13/2005
Last Update Date	:	08/06/2010

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