Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207YS0123X | Facial Plastic Surgeon | G36897 | CA |
N | 208200000X | Surgeon | G36897 | CA |
N | 208600000X | Surgeon | G36897 | CA |
NPI | 1619029113 |
---|---|
Provider Name | Jeffry Ben Schafer |
First Address | Coronado, CA 92118-1978 |
Second Address | Coronado, CA 92118-1978 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/01/2007 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00G368970 | (05) | CA |
A46856 | (02) | CA |