1902806532 NPI number — DR. GARY FRANCIS SCHOONOVER D.M.D.

Table of content: DR. GARY FRANCIS SCHOONOVER D.M.D. (NPI 1902806532)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1902806532 NPI number — DR. GARY FRANCIS SCHOONOVER D.M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SCHOONOVER
Provider First Name:
GARY
Provider Middle Name:
FRANCIS
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.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:
1902806532
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
03/25/2006
NPI Reactivation Date:
08/31/2006

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1324 GWINN WAY SE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SALEM
Provider Business Mailing Address State Name:
OR
Provider Business Mailing Address Postal Code:
97301-9498
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
503-316-1817
Provider Business Mailing Address Fax Number:
503-390-5931

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4320 CHERRY AVE NE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KEIZER
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97303-4855
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
503-390-2421
Provider Business Practice Location Address Fax Number:
503-390-5931
Provider Enumeration Date:
07/26/2005

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: 1223G0001X , with the licence number:  5524 , registered in the state of OR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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