Provider Demographics
NPI:1235157868
Name:SCHROEDER, JAY STUART (MD)
Entity Type:Individual
Prefix:
First Name:JAY
Middle Name:STUART
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:PO BOX 34120
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89533-4120
Mailing Address - Country:US
Mailing Address - Phone:775-747-5050
Mailing Address - Fax:775-747-5005
Practice Address - Street 1:18653 WEDGE PARKWAY
Practice Address - Street 2:SUITE 120
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89511-3007
Practice Address - Country:US
Practice Address - Phone:775-853-7997
Practice Address - Fax:775-853-7984
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-18
Last Update Date:2010-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV7451207R00000X
CAG83146207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV002016288Medicaid
V101126Medicare PIN
G11837Medicare UPIN
NV101127Medicare PIN