Provider Demographics
NPI:1134126600
Name:SCHROEDER, JENNIFER A (MD)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:A
Last Name:SCHROEDER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:2708 RIFE MEDICAL LANE
Mailing Address - Street 2:SUITE 130
Mailing Address - City:ROGERS
Mailing Address - State:AR
Mailing Address - Zip Code:72758-1452
Mailing Address - Country:US
Mailing Address - Phone:479-338-5555
Mailing Address - Fax:479-338-5533
Practice Address - Street 1:2708 RIFE MEDICAL LANE
Practice Address - Street 2:SUITE 130
Practice Address - City:ROGERS
Practice Address - State:AR
Practice Address - Zip Code:72758-1452
Practice Address - Country:US
Practice Address - Phone:479-338-5555
Practice Address - Fax:479-338-5533
Is Sole Proprietor?:No
Enumeration Date:2005-06-30
Last Update Date:2011-09-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXK6502207Q00000X
ARE3089207Q00000X
ARE-3089207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR162462901Medicaid
TX162462901Medicaid
AR8B2177Medicare PIN
AR162462901Medicaid
H49848Medicare UPIN