Provider Demographics
NPI:1083658926
Name:SCHROEDER, STEPHEN M (DPM)
Entity Type:Individual
Prefix:MR
First Name:STEPHEN
Middle Name:M
Last Name:SCHROEDER
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7300 SW CHILDS RD
Mailing Address - Street 2:#B
Mailing Address - City:TIGARD
Mailing Address - State:OR
Mailing Address - Zip Code:97224
Mailing Address - Country:US
Mailing Address - Phone:503-692-8700
Mailing Address - Fax:503-692-8710
Practice Address - Street 1:7300 SW CHILDS RD
Practice Address - Street 2:#B
Practice Address - City:TIGARD
Practice Address - State:OR
Practice Address - Zip Code:97224
Practice Address - Country:US
Practice Address - Phone:503-692-8700
Practice Address - Fax:503-692-8710
Is Sole Proprietor?:No
Enumeration Date:2006-06-15
Last Update Date:2020-08-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WAPO00000744213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8368466Medicaid
WA8368466Medicaid