Provider Demographics
NPI:1376696013
Name:SCHMIEDT, RUDOLF THOMAS I (MD)
Entity Type:Individual
Prefix:DR
First Name:RUDOLF
Middle Name:THOMAS
Last Name:SCHMIEDT
Suffix:I
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:30960 STAGECOACH BLVD
Mailing Address - Street 2:SUITE W-120
Mailing Address - City:EVERGREEN
Mailing Address - State:CO
Mailing Address - Zip Code:80439-7902
Mailing Address - Country:US
Mailing Address - Phone:303-674-6671
Mailing Address - Fax:303-674-0031
Practice Address - Street 1:30960 STAGECOACH BLVD
Practice Address - Street 2:SUITE W-120
Practice Address - City:EVERGREEN
Practice Address - State:CO
Practice Address - Zip Code:80439-7902
Practice Address - Country:US
Practice Address - Phone:303-674-6671
Practice Address - Fax:303-674-0031
Is Sole Proprietor?:No
Enumeration Date:2007-01-18
Last Update Date:2018-04-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CO34411208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO40308332Medicaid