Provider Demographics
NPI:1275538571
Name:SCHWARTZ, GARY S (MD)
Entity Type:Individual
Prefix:
First Name:GARY
Middle Name:S
Last Name:SCHWARTZ
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 1:1719 TOWER DR W
Mailing Address - Street 2:STE 100
Mailing Address - City:STILLWATER
Mailing Address - State:MN
Mailing Address - Zip Code:55082-7512
Mailing Address - Country:US
Mailing Address - Phone:651-275-3000
Mailing Address - Fax:651-275-3027
Practice Address - Street 1:237 RADIO DR STE 100
Practice Address - Street 2:
Practice Address - City:WOODBURY
Practice Address - State:MN
Practice Address - Zip Code:55125-4478
Practice Address - Country:US
Practice Address - Phone:651-275-3000
Practice Address - Fax:651-275-3027
Is Sole Proprietor?:No
Enumeration Date:2005-06-15
Last Update Date:2020-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN35829207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI180046284OtherRAILROAD MEDICARE
MN131707500Medicaid
MN180023450OtherRAILROAD MEDICARE
F42865Medicare UPIN
WI180046284OtherRAILROAD MEDICARE
MN180000537Medicare PIN