Provider Demographics
NPI:1346265782
Name:SCHNEIDER, GARY S (DO)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:S
Last Name:SCHNEIDER
Suffix:
Gender:M
Credentials:DO
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Mailing Address - Street 1:4835 VAN NUYS BLVD STE 109
Mailing Address - Street 2:
Mailing Address - City:SHERMAN OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91403-2134
Mailing Address - Country:US
Mailing Address - Phone:818-905-9586
Mailing Address - Fax:818-905-0130
Practice Address - Street 1:4835 VAN NUYS BLVD STE 109
Practice Address - Street 2:
Practice Address - City:SHERMAN OAKS
Practice Address - State:CA
Practice Address - Zip Code:91403-2134
Practice Address - Country:US
Practice Address - Phone:818-905-9586
Practice Address - Fax:818-905-0130
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-13
Last Update Date:2024-04-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA20A4198207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00AX41980Medicaid
CA00AX41980Medicaid
CA20A4198Medicare ID - Type Unspecified