Provider Demographics
NPI:1548364847
Name:SCHAEFFER, PHILIP ALAN (MD)
Entity type:Individual
Prefix:MR
First Name:PHILIP
Middle Name:ALAN
Last Name:SCHAEFFER
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:PO BOX 7827
Mailing Address - Street 2:
Mailing Address - City:GULFPORT
Mailing Address - State:MS
Mailing Address - Zip Code:39506-7827
Mailing Address - Country:US
Mailing Address - Phone:228-897-7730
Mailing Address - Fax:228-575-0886
Practice Address - Street 1:1403 43RD AVE
Practice Address - Street 2:
Practice Address - City:GULFPORT
Practice Address - State:MS
Practice Address - Zip Code:39501-2545
Practice Address - Country:US
Practice Address - Phone:228-897-7730
Practice Address - Fax:228-575-0886
Is Sole Proprietor?:No
Enumeration Date:2006-09-08
Last Update Date:2010-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS116742084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
B62026Medicare UPIN
26000012Medicare ID - Type Unspecified