1952382111 NPI number — DR. ALAN CONRAD SCHROEDER MD

Table of content: DR. ALAN CONRAD SCHROEDER MD (NPI 1952382111)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1952382111 NPI number — DR. ALAN CONRAD SCHROEDER MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SCHROEDER
Provider First Name:
ALAN
Provider Middle Name:
CONRAD
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
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:
1952382111
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/10/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
07/17/2007
NPI Reactivation Date:
03/18/2008

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7301 HENNESSY BLVD
Provider Second Line Business Mailing Address:
SUITE 200
Provider Business Mailing Address City Name:
BATON ROUGE
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
70808-4384
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
225-766-0050
Provider Business Mailing Address Fax Number:
225-766-1499

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7301 HENNESSY BLVD
Provider Second Line Business Practice Location Address:
SUITE 200
Provider Business Practice Location Address City Name:
BATON ROUGE
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70808-4384
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
225-766-0050
Provider Business Practice Location Address Fax Number:
225-766-1499
Provider Enumeration Date:
11/07/2005

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: 207X00000X , with the licence number:  17511 , registered in the state of MS ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207X00000X , with the licence number: 200406 , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207XX0005X , with the licence number: 200406 , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1215929 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".




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