Individual
DR. CHARLES SCHAEFFER HERTZ JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1691 GALISTEO ST, SUITE C, SANTA FE, NM 87505-4780
(505) 983-5631
(505) 982-5605
Mailing address
1691 GALISTEO ST, SUITE C, SANTA FE, NM 87505-4780
(505) 983-5631
(505) 982-5605
Taxonomy
Speciality
Code
Description
License number
State
207RG0100X
Gastroenterology Physician
13380
TN
207RG0100X
Gastroenterology Physician
Primary
MD2011-0092
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
100006289
RAILROAD MEDICARE
TN
05
—
3187049
—
TN
01
—
4466329
AETNA PROVIDER NUMBER
TN
01
—
4748210
CIGNA HEALTHCARE
TN
01
—
53765
BCBS PROVIDER NUMBER
TN
01
—
8160
TLC PROVIDER NUMBER
TN
Enumeration date
05/17/2006
Last updated
07/27/2011
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