Provider Demographics
NPI:1235310574
Name:KEITH S SCHAUDER MD PA
Entity Type:Organization
Organization Name:KEITH S SCHAUDER MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KEITH
Authorized Official - Middle Name:STEWART
Authorized Official - Last Name:SCHAUDER
Authorized Official - Suffix:
Authorized Official - Credentials:MD PA
Authorized Official - Phone:281-331-3100
Mailing Address - Street 1:PO BOX 7887
Mailing Address - Street 2:
Mailing Address - City:BELFAST
Mailing Address - State:ME
Mailing Address - Zip Code:04915-7800
Mailing Address - Country:US
Mailing Address - Phone:281-331-3100
Mailing Address - Fax:281-756-8537
Practice Address - Street 1:1 MEDIC LN
Practice Address - Street 2:
Practice Address - City:ALVIN
Practice Address - State:TX
Practice Address - Zip Code:77511-5895
Practice Address - Country:US
Practice Address - Phone:281-331-3100
Practice Address - Fax:281-756-8537
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-15
Last Update Date:2022-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH0791207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00G33GMedicare PIN