Provider Demographics
NPI:1245205293
Name:SCHOONOVER, JEFFERY P (MD)
Entity Type:Individual
Prefix:DR
First Name:JEFFERY
Middle Name:P
Last Name:SCHOONOVER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:11876 OLIO RD
Mailing Address - Street 2:SUITE 700
Mailing Address - City:FISHERS
Mailing Address - State:IN
Mailing Address - Zip Code:46037-9765
Mailing Address - Country:US
Mailing Address - Phone:317-348-3023
Mailing Address - Fax:317-863-1237
Practice Address - Street 1:11876 OLIO RD
Practice Address - Street 2:SUITE 700
Practice Address - City:FISHERS
Practice Address - State:IN
Practice Address - Zip Code:46037-9765
Practice Address - Country:US
Practice Address - Phone:317-348-3023
Practice Address - Fax:317-863-1237
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-22
Last Update Date:2015-01-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IN01060951207Q00000X
IN01060951A202K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes202K00000XAllopathic & Osteopathic PhysiciansPhlebology
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200531400Medicaid
IN200531400Medicaid
IN200531400Medicaid