Provider Demographics
NPI:1427022755
Name:SCHOENFELD, ALEXANDER L (MD)
Entity Type:Individual
Prefix:
First Name:ALEXANDER
Middle Name:L
Last Name:SCHOENFELD
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 1:4020 SERANGO CT
Mailing Address - Street 2:
Mailing Address - City:WEST LINN
Mailing Address - State:OR
Mailing Address - Zip Code:97068-2840
Mailing Address - Country:US
Mailing Address - Phone:520-343-9734
Mailing Address - Fax:
Practice Address - Street 1:101 COLE AVE
Practice Address - Street 2:
Practice Address - City:BISBEE
Practice Address - State:AZ
Practice Address - Zip Code:85603-1327
Practice Address - Country:US
Practice Address - Phone:520-432-5383
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-14
Last Update Date:2020-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC51637207P00000X
WA60717765207P00000X
AZ37752207P00000X
OR161224207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT500HBE168CT01OtherBLUECROSS BLUESHIELD
CT500HBE168CT01OtherBLUECROSS BLUESHIELD
G50062Medicare UPIN
CACI438ZMedicare PIN