Provider Demographics
NPI:1154475101
Name:SCHMIDT, JARED LEE (MD)
Entity Type:Individual
Prefix:
First Name:JARED
Middle Name:LEE
Last Name:SCHMIDT
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:PO BOX 2036
Mailing Address - Street 2:
Mailing Address - City:BISMARCK
Mailing Address - State:ND
Mailing Address - Zip Code:58502-2036
Mailing Address - Country:US
Mailing Address - Phone:701-222-2480
Mailing Address - Fax:701-222-4537
Practice Address - Street 1:3502 FRANKLIN AVE
Practice Address - Street 2:
Practice Address - City:BISMARCK
Practice Address - State:ND
Practice Address - Zip Code:58503-0761
Practice Address - Country:US
Practice Address - Phone:701-222-2480
Practice Address - Fax:701-222-4537
Is Sole Proprietor?:No
Enumeration Date:2007-01-23
Last Update Date:2011-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD7916207ZP0102X
ND11718207ZP0102X
MN52622207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND16493Medicaid
NDN716889Medicare PIN