Provider Demographics
NPI:1497713416
Name:SCHMIDT, DONOVAN (DO)
Entity Type:Individual
Prefix:DR
First Name:DONOVAN
Middle Name:
Last Name:SCHMIDT
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3909
Mailing Address - Street 2:
Mailing Address - City:KINGMAN
Mailing Address - State:AZ
Mailing Address - Zip Code:86402-3909
Mailing Address - Country:US
Mailing Address - Phone:928-753-3303
Mailing Address - Fax:928-753-3603
Practice Address - Street 1:2002 STOCKTON HILL RD
Practice Address - Street 2:SUITE 103
Practice Address - City:KINGMAN
Practice Address - State:AZ
Practice Address - Zip Code:86401-4698
Practice Address - Country:US
Practice Address - Phone:928-753-3303
Practice Address - Fax:928-753-3603
Is Sole Proprietor?:No
Enumeration Date:2006-05-01
Last Update Date:2010-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ2768207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ860373636OtherHUMANA GROUP
AZ3981220OtherEVERCARE
AZAZ0728670OtherBLUE CROSS BLUE SHIELD GR
AZ057324Medicaid
AZ453051001OtherGROUP HEALTH GRP
AZAW1436OtherHEALTHNET GRP
AZ453051001OtherGROUP HEALTH GRP
AZAW1436OtherHEALTHNET GRP