Provider Demographics
NPI:1225131147
Name:SCHMIDT, JAY MELVIN (PA C)
Entity Type:Individual
Prefix:
First Name:JAY
Middle Name:MELVIN
Last Name:SCHMIDT
Suffix:
Gender:M
Credentials:PA C
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Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:10100 SE SUNNYSIDE ROAD
Mailing Address - Street 2:MT TALBERT MEDICAL OFFICE DEPT OF NEUROSURGERY
Mailing Address - City:CLACKAMAS
Mailing Address - State:OR
Mailing Address - Zip Code:97015
Mailing Address - Country:US
Mailing Address - Phone:503-571-4228
Mailing Address - Fax:503-571-3601
Practice Address - Street 1:10100 SE SUNNYSIDE ROAD
Practice Address - Street 2:MT TALBERT MEDICAL OFFICE DEPT OF NEUROSURGERY
Practice Address - City:CLACKAMAS
Practice Address - State:OR
Practice Address - Zip Code:97015
Practice Address - Country:US
Practice Address - Phone:503-571-4228
Practice Address - Fax:503-571-3601
Is Sole Proprietor?:No
Enumeration Date:2006-09-06
Last Update Date:2008-06-09
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
ORPA00646363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical