Provider Demographics
NPI:1275614596
Name:SCHMIDT, BRIAN FREDERICK (MD)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:FREDERICK
Last Name:SCHMIDT
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 1:3536 MENDOCINO AVE
Mailing Address - Street 2:STE 200
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95403-3634
Mailing Address - Country:US
Mailing Address - Phone:707-525-6485
Mailing Address - Fax:707-523-0616
Practice Address - Street 1:1701 4TH ST
Practice Address - Street 2:STE 200
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95404-3601
Practice Address - Country:US
Practice Address - Phone:707-579-2100
Practice Address - Fax:707-523-0616
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2021-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG524292086S0127X, 2086S0129X, 208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No2086S0127XAllopathic & Osteopathic PhysiciansSurgeryTrauma Surgery
No2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAP00469232OtherRAILROAD MEDICARE
CA00G524290OtherBLUE SHIELD OF CALIFORNIA
CA1275614596Medicaid
CAP00469232OtherRAILROAD MEDICARE
CA1275614596Medicaid