Provider Demographics
NPI:1093792301
Name:SCHAUER, JUDY ROLAND (DO)
Entity Type:Individual
Prefix:MRS
First Name:JUDY
Middle Name:ROLAND
Last Name:SCHAUER
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:JUDY
Other - Middle Name:ROLAND
Other - Last Name:KIMBROUGH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSPH
Mailing Address - Street 1:804 ENGLISH ROAD, SUITE 100
Mailing Address - Street 2:
Mailing Address - City:ROCKY MOUNT
Mailing Address - State:NC
Mailing Address - Zip Code:27804
Mailing Address - Country:US
Mailing Address - Phone:252-443-3133
Mailing Address - Fax:252-443-6726
Practice Address - Street 1:804 ENGLISH ROAD, SUITE 100
Practice Address - Street 2:
Practice Address - City:ROCKY MOUNT
Practice Address - State:NC
Practice Address - Zip Code:27804
Practice Address - Country:US
Practice Address - Phone:252-443-3133
Practice Address - Fax:252-443-6726
Is Sole Proprietor?:No
Enumeration Date:2005-12-28
Last Update Date:2019-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCNC-2017-00154207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
000OTHMedicare UPIN