Provider Demographics
NPI:1508927898
Name:SCHNEIDEWIND, BARRY S (DO)
Entity Type:Individual
Prefix:
First Name:BARRY
Middle Name:S
Last Name:SCHNEIDEWIND
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 1:10470 OLD PLACERVILLE RD
Mailing Address - Street 2:ST 100
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95827-2539
Mailing Address - Country:US
Mailing Address - Phone:800-470-0071
Mailing Address - Fax:
Practice Address - Street 1:685 TWELVE BRIDGES DR
Practice Address - Street 2:#B
Practice Address - City:LINCOLN
Practice Address - State:CA
Practice Address - Zip Code:95648-8689
Practice Address - Country:US
Practice Address - Phone:916-408-5915
Practice Address - Fax:916-408-5401
Is Sole Proprietor?:No
Enumeration Date:2006-12-12
Last Update Date:2015-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A5389207Q00000X, 2083X0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00AX53890Medicaid
020A53890Medicare ID - Type Unspecified
CA00AX53890Medicaid