Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207SG0201X | Clinical Genetics (M.D.) | 18185 | NE |
Y | 207SG0201X | Clinical Genetics (M.D.) | E5822 | AR |
N | 2080P0205X | Pediatric Endocrinologist | 18185 | NE |
N | 2080P0205X | Pediatric Endocrinologist | E5822 | AR |
NPI | 1225089204 |
---|---|
Provider Name | Gerald Bradley Schaefer |
First Address | Little Rock, AR 72202-3500 |
Second Address | Springdale, AR 72762-0845 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/05/2006 |
Last Update Date | 04/10/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
126153001 | (05) | AR |
E11718 | (02) | NE |