Provider Demographics
NPI:1366614356
Name:JEANNE M SCHAEFER MD PLLC
Entity type:Organization
Organization Name:JEANNE M SCHAEFER MD PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JEANNE
Authorized Official - Middle Name:M
Authorized Official - Last Name:SCHAEFER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:405-509-6777
Mailing Address - Street 1:PO BOX 270
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73083-0270
Mailing Address - Country:US
Mailing Address - Phone:405-509-6777
Mailing Address - Fax:405-509-6778
Practice Address - Street 1:523 S SANTA FE AVE STE B
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73003-6291
Practice Address - Country:US
Practice Address - Phone:405-509-6777
Practice Address - Fax:405-509-6778
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-31
Last Update Date:2020-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200071190AMedicaid