Provider Demographics
NPI:1427039643
Name:SCHMIDT, JONIRAI (PA-C)
Entity Type:Individual
Prefix:
First Name:JONIRAI
Middle Name:
Last Name:SCHMIDT
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2505 W BELT LINE RD
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:TX
Mailing Address - Zip Code:75146-1930
Mailing Address - Country:US
Mailing Address - Phone:972-230-8290
Mailing Address - Fax:972-230-8274
Practice Address - Street 1:2505 W BELT LINE RD
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:TX
Practice Address - Zip Code:75146-1930
Practice Address - Country:US
Practice Address - Phone:972-230-8290
Practice Address - Fax:972-230-8274
Is Sole Proprietor?:No
Enumeration Date:2005-11-07
Last Update Date:2010-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3113363A00000X
TXPA06475363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ897374Medicaid
AZQ18373Medicare UPIN
AZ897374Medicaid