Provider Demographics
NPI:1275676520
Name:SCHOONMAKER, GENE M (MD)
Entity Type:Individual
Prefix:DR
First Name:GENE
Middle Name:M
Last Name:SCHOONMAKER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:PO BOX 2580
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65801-2580
Mailing Address - Country:US
Mailing Address - Phone:417-829-4620
Mailing Address - Fax:417-829-4316
Practice Address - Street 1:3231 S NATIONAL AVE
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65807-7304
Practice Address - Country:US
Practice Address - Phone:417-885-0803
Practice Address - Fax:417-841-0110
Is Sole Proprietor?:No
Enumeration Date:2007-02-15
Last Update Date:2008-07-23
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MOR8F16207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO202269924Medicaid
MO98111OtherAR BLUE SHIELD #
AR112517001Medicaid
AR112517001Medicaid
MO202269924Medicaid