Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VX0000X | Obstetrician | A40008 | CA |
NPI | 1376645267 |
---|---|
Provider Name | Mr. James Roland Schaefer |
First Address | La Mesa, CA 91942-3045 |
Second Address | La Mesa, CA 91942-3045 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/09/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00A400080 | (05) | CA |
A40008 | (05) | CA |
A85361 | (02) |