Provider Demographics
NPI:1346356557
Name:SCHMIDT, MARK ALLAN (PSY D)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:ALLAN
Last Name:SCHMIDT
Suffix:
Gender:M
Credentials:PSY D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 UNIVERSITY BLVD
Mailing Address - Street 2:
Mailing Address - City:TUSCALOOSA
Mailing Address - State:AL
Mailing Address - Zip Code:35401-1250
Mailing Address - Country:US
Mailing Address - Phone:205-759-0799
Mailing Address - Fax:205-759-0845
Practice Address - Street 1:200 UNIVERSITY BLVD
Practice Address - Street 2:BRYCE HOSPITAL
Practice Address - City:TUSCALOOSA
Practice Address - State:AL
Practice Address - Zip Code:35401-1250
Practice Address - Country:US
Practice Address - Phone:205-759-0799
Practice Address - Fax:205-759-0845
Is Sole Proprietor?:No
Enumeration Date:2006-08-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1061103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
P00037809OtherRR GROUP
51000798OtherBCBS
P36409Medicare UPIN