Provider Demographics
NPI:1326154352
Name:SCHWARTZ, STEPHEN D (MD)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:D
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 1:4727A HOEN AVE
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95405-7862
Mailing Address - Country:US
Mailing Address - Phone:707-527-0342
Mailing Address - Fax:707-527-0818
Practice Address - Street 1:4727A HOEN AVE
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95405-7862
Practice Address - Country:US
Practice Address - Phone:707-527-0342
Practice Address - Fax:707-527-0818
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-22
Last Update Date:2008-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA24347207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A243470Medicaid
CA00A243470Medicare PIN
CAA23933Medicare UPIN