Provider Demographics
NPI:1215925334
Name:SCHAFER, RANDAL E (MD)
Entity type:Individual
Prefix:DR
First Name:RANDAL
Middle Name:E
Last Name:SCHAFER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:246 HOSPITAL DR
Mailing Address - Street 2:
Mailing Address - City:UKIAH
Mailing Address - State:CA
Mailing Address - Zip Code:95482-4533
Mailing Address - Country:US
Mailing Address - Phone:707-463-8011
Mailing Address - Fax:707-463-8044
Practice Address - Street 1:246 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:UKIAH
Practice Address - State:CA
Practice Address - Zip Code:95482-4533
Practice Address - Country:US
Practice Address - Phone:707-463-8011
Practice Address - Fax:707-463-8044
Is Sole Proprietor?:No
Enumeration Date:2005-10-12
Last Update Date:2015-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00039196208600000X
CAG55726208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAAB32999OtherMEDICARE GROUP
0151119OtherL & I
WAGAB36602Medicare ID - Type Unspecified
WA8265415Medicaid
WAG8864783Medicare PIN
8929403OtherL & I CRIME VICTIMS
A53023Medicare UPIN