Provider Demographics
NPI:1083177224
Name:SCHNEIDER, ETHAN CLAY (MD)
Entity Type:Individual
Prefix:
First Name:ETHAN
Middle Name:CLAY
Last Name:SCHNEIDER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:933 E. PIERCE ST.
Mailing Address - Street 2:
Mailing Address - City:COUNCIL BLUFFS
Mailing Address - State:IA
Mailing Address - Zip Code:51503-4626
Mailing Address - Country:US
Mailing Address - Phone:712-396-4360
Mailing Address - Fax:712-396-7069
Practice Address - Street 1:933 E. PIERCE ST.
Practice Address - Street 2:
Practice Address - City:COUNCIL BLUFFS
Practice Address - State:IA
Practice Address - Zip Code:51503-4626
Practice Address - Country:US
Practice Address - Phone:712-396-4360
Practice Address - Fax:712-396-7069
Is Sole Proprietor?:No
Enumeration Date:2019-04-12
Last Update Date:2023-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI77345207Q00000X
IAMD-51235208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine