Provider Demographics
NPI:1902985393
Name:SCHAFER, JOHN A (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:A
Last Name:SCHAFER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3400 DATA DR
Mailing Address - Street 2:
Mailing Address - City:RANCHO CORDOVA
Mailing Address - State:CA
Mailing Address - Zip Code:95670-7956
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6555 COYLE AVE
Practice Address - Street 2:
Practice Address - City:CARMICHAEL
Practice Address - State:CA
Practice Address - Zip Code:95608-0302
Practice Address - Country:US
Practice Address - Phone:916-733-5701
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-04
Last Update Date:2012-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG259262084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG25926OtherBLUE CROSS
CA00G259260OtherBLUE SHIELD
CA00G259260Medicaid
CA1211062OtherUNITED HEALTHCARE
CA655115OtherGREAT WEST
CA90021567OtherPACIFICARE
CA217071OtherCIGNA
CA4806OtherFIRST HEALTH
CAMCMG171800OtherWESTERN HEALTH ADVANTAGE
CA000810354313OtherPHCS
CA015065OtherHEALTH NET
CA4056270OtherAETNA
CA16744OtherINTERPLAN
CA655115OtherGREAT WEST
CA16744OtherINTERPLAN