1821086208 NPI number — DR. PAUL D SCHNEIDER M.D.

Table of content: DR. PAUL D SCHNEIDER M.D. (NPI 1821086208)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1821086208 NPI number — DR. PAUL D SCHNEIDER M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SCHNEIDER
Provider First Name:
PAUL
Provider Middle Name:
D
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1821086208
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/04/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10510 GRAVELLY LAKE DR SW
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TACOMA
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98499-5036
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
253-597-7030
Provider Business Mailing Address Fax Number:
253-597-7033

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10510 GRAVELLY LAKE DR SW
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAKEWOOD
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98499-5036
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-589-7030
Provider Business Practice Location Address Fax Number:
253-589-7033
Provider Enumeration Date:
10/11/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  MD000015726 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207RN0300X , with the licence number: MD000015726 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0065674 . This is a "LABOR AND INDUSTRIES" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 4423SC . This is a "REGENCE BS SPECIALIST" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 538388831 . This is a "CIGNA" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 0190391 . This is a "OMAC-IME" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 911503824 . This is a "KITSAP HEALTH PLANS" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 215253001 . This is a "GROUP HEALTH WASHINGTON" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 1062991 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 911503824 . This is a "TRICARE" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 911503824 . This is a "PACIFICARE WASHINGTON" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 4668902 . This is a "AETHA INSURANCES" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 911503824 . This is a "MOLINA HEALTH CARE" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 911503827 . This is a "PRIVATE HEALTHCARE SYSTEM" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 0180985 . This is a "LABOR & INDUSTRIES IME" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 6611SC . This is a "REGENCE BS PRIMARY CARE" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 911503827 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 911503827 . This is a "FIRST CHOICE HEALTH PLANS" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".




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