Provider Demographics
NPI:1174738769
Name:J. C. SCHOFFLER, DPM PC
Entity type:Organization
Organization Name:J. C. SCHOFFLER, DPM PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:SHARLA
Authorized Official - Middle Name:N
Authorized Official - Last Name:FANNIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-886-8741
Mailing Address - Street 1:2608 HARWOOD RD
Mailing Address - Street 2:
Mailing Address - City:BEDFORD
Mailing Address - State:TX
Mailing Address - Zip Code:76021-3700
Mailing Address - Country:US
Mailing Address - Phone:817-283-7288
Mailing Address - Fax:
Practice Address - Street 1:2906 HIGHGROVE CT
Practice Address - Street 2:
Practice Address - City:COLLEYVILLE
Practice Address - State:TX
Practice Address - Zip Code:76034
Practice Address - Country:US
Practice Address - Phone:817-832-1182
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-14
Last Update Date:2018-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXDB2922OtherPALMETTO GBA
TXDB2922OtherPALMETTO GBA
TX87Z921Medicare ID - Type UnspecifiedJEROME C SCHOFFLER, DPM
TXT15774Medicare UPIN
TX0800800001Medicare NSC