Provider Demographics
NPI:1699764050
Name:SCHAFER, NATHAN C (MD)
Entity type:Individual
Prefix:DR
First Name:NATHAN
Middle Name:C
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 1:186 WILDERNESS PT
Mailing Address - Street 2:
Mailing Address - City:EVANSTON
Mailing Address - State:WY
Mailing Address - Zip Code:82930-4632
Mailing Address - Country:US
Mailing Address - Phone:307-789-5607
Mailing Address - Fax:
Practice Address - Street 1:WYOMING STATE HOSPITAL
Practice Address - Street 2:HIGHWAY 150 SOUTH
Practice Address - City:EVANSTON
Practice Address - State:WY
Practice Address - Zip Code:82930-9266
Practice Address - Country:US
Practice Address - Phone:307-789-3464
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY5930A207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WYD87686Medicare UPIN