Provider Demographics
NPI:1225091226
Name:SCHROEDER, PAUL W (MD)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:W
Last Name:SCHROEDER
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 1:1910 E BARNETT RD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97504-8262
Mailing Address - Country:US
Mailing Address - Phone:541-770-2556
Mailing Address - Fax:541-770-2557
Practice Address - Street 1:1910 E BARNETT RD
Practice Address - Street 2:SUITE 102
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97504-8262
Practice Address - Country:US
Practice Address - Phone:541-770-2556
Practice Address - Fax:541-770-2557
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR13458174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR283168OtherOMAP
ORE21858Medicare UPIN
OR116276Medicare ID - Type Unspecified