Basic Information
| Provider Information | |||||||||
| NPI: | 1720515828 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SCHAFER | ||||||||
| FirstName: | RAMON | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | JR. | ||||||||
| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2200 E SHOW LOW LAKE RD | ||||||||
| Address2: | |||||||||
| City: | SHOW LOW | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 859017831 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9285376393 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 2352 QUARTER HORSE TRAIL | ||||||||
| Address2: | |||||||||
| City: | OVERGAARD | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 85933 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9285353616 | ||||||||
| FaxNumber: | 9285353615 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/19/2017 | ||||||||
| LastUpdateDate: | 06/29/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/29/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 207Q00000X | 008098 | AZ | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 003642 | 05 | AZ | MEDICAID |