Provider Demographics
NPI:1053308882
Name:SCHOTT, STEPHAN N (DO)
Entity Type:Individual
Prefix:
First Name:STEPHAN
Middle Name:N
Last Name:SCHOTT
Suffix:
Gender:M
Credentials:DO
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 3857
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37043-0857
Mailing Address - Country:US
Mailing Address - Phone:931-648-1920
Mailing Address - Fax:931-503-0346
Practice Address - Street 1:306 LANDRUM PL
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37043-4648
Practice Address - Country:US
Practice Address - Phone:931-648-1920
Practice Address - Fax:931-503-0346
Is Sole Proprietor?:No
Enumeration Date:2005-10-06
Last Update Date:2011-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TND0769207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3712519Medicaid
TN990009439Medicare PIN
TNF03045Medicare UPIN
TN3302276Medicare PIN