Doctor Name: | MR. CHARLES JOHN SCHOEPHOERSTER |
NPI Number: | 1629264080 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | PA-C |
License Number: | 665 |
Business Practice Address: | 559 Vincent St Attn: 21 Mdos/sgof - Family Practice Peterson Afb, CO - 809141540 |
Business Phone Number: | 7195562273 |
Business Fax Number: | 8668677926 |
Mailing Address: | 559 Vincent St, Attn: 21 Mdos/sgof - Family Practice PETERSON AFB |
State: | CO |
Postal Code: | 809141540 |
Phone Number: | 7195562273 |
Fax Number: | 8668677926 |
NPI Enumeration Date: | 09/19/2007 |
NPI Last Update Date: | 04/02/2009 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363AM0700X |
License Number: | 665 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | CO |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Physician Assistant |
Taxonomy Specialization: | Medical |
Taxonomy Definition: |