Provider Demographics
NPI:1386605228
Name:SCHAFER, JOHN RAY (MD)
Entity type:Individual
Prefix:MR
First Name:JOHN
Middle Name:RAY
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 1:270 PERKINS STREET
Mailing Address - Street 2:
Mailing Address - City:SONOMA
Mailing Address - State:CA
Mailing Address - Zip Code:95476-6955
Mailing Address - Country:US
Mailing Address - Phone:707-938-3131
Mailing Address - Fax:707-938-3678
Practice Address - Street 1:270 PERKINS STREET
Practice Address - Street 2:
Practice Address - City:SONOMA
Practice Address - State:CA
Practice Address - Zip Code:95476-6955
Practice Address - Country:US
Practice Address - Phone:707-938-3131
Practice Address - Fax:707-938-3678
Is Sole Proprietor?:No
Enumeration Date:2006-03-30
Last Update Date:2015-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG62440207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAYYY48627YOtherMCR MM
CAYYY48627YMedicaid
CAYYY48627YMedicaid
A57470Medicare UPIN
00G62440Medicare PIN