Doctor Name: | KYLE SCHAEFER |
NPI Number: | 1124373287 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | MS, PA-C |
License Number: | |
Business Practice Address: | 181 W Meadow Dr Ste 400 Vail, CO - 816575058 |
Business Phone Number: | 9704761100 |
Business Fax Number: | |
Mailing Address: | 2200neneff Rd 200, BEND |
State: | OR |
Postal Code: | 977014281 |
Phone Number: | 5413823344 |
Fax Number: | 5413821681 |
NPI Enumeration Date: | 07/16/2012 |
NPI Last Update Date: | 08/26/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363AS0400X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Physician Assistant |
Taxonomy Specialization: | Surgical |
Taxonomy Definition: |