Provider Demographics
NPI:1386622363
Name:SCHAEFFER, CAMERON SHERWOOD (MD)
Entity type:Individual
Prefix:DR
First Name:CAMERON
Middle Name:SHERWOOD
Last Name:SCHAEFFER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:CAMERON
Other - Middle Name:SHERWOOD
Other - Last Name:SCHAEFFER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:169 BURT RD
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40503-2455
Mailing Address - Country:US
Mailing Address - Phone:859-278-9242
Mailing Address - Fax:859-277-0240
Practice Address - Street 1:1760 NICHOLASVILLE RD STE 601
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40503-1474
Practice Address - Country:US
Practice Address - Phone:859-275-5437
Practice Address - Fax:859-275-5434
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-09
Last Update Date:2021-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY31252174400000X, 208200000X, 208800000X, 2088P0231X
FLME1387802088P0231X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2088P0231XAllopathic & Osteopathic PhysiciansUrologyPediatric Urology
No174400000XOther Service ProvidersSpecialist
No208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
No208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY753019922OtherTAX ID
FL101778900Medicaid
KY64010481Medicaid