Provider Demographics
NPI:1497713689
Name:SCHEXNAYDER, JERRY A (MD)
Entity Type:Individual
Prefix:
First Name:JERRY
Middle Name:A
Last Name:SCHEXNAYDER
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 1:2829 E HIGHWAY 76
Mailing Address - Street 2:
Mailing Address - City:MULLINS
Mailing Address - State:SC
Mailing Address - Zip Code:29574-6035
Mailing Address - Country:US
Mailing Address - Phone:843-431-2280
Mailing Address - Fax:843-431-2297
Practice Address - Street 1:2829 E HIGHWAY 76
Practice Address - Street 2:
Practice Address - City:MULLINS
Practice Address - State:SC
Practice Address - Zip Code:29574-6035
Practice Address - Country:US
Practice Address - Phone:843-431-2280
Practice Address - Fax:843-431-2297
Is Sole Proprietor?:No
Enumeration Date:2006-05-04
Last Update Date:2012-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC18802207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC1129707004OtherCIGNA
SC632831OtherAETNA HMO NETWORK
PA01839531Medicaid
WV1061050OtherWV WORKERS COMPENSATION
SC188022Medicaid
NC890511LMedicaid
NY0599453OtherGHI
SC720507OtherMB EVOLUTIONS
SC232753OtherCHOICECARE
AL263155OtherONE HEALTH
SC873957OtherFIRST HEALTH
SCGP5462Medicaid
SC720506OtherMI EVOLUTIONS
NCA154OtherNC UHC
SC5417700OtherHEALTHSOURCE/CIGNA
SC5828006OtherAETNA OPEN NETWORK
SC720507OtherMB EVOLUTIONS
WV1061050OtherWV WORKERS COMPENSATION
SCGP9493Medicare PIN