Provider Demographics
NPI:1568664308
Name:SCHNEIDER, HOWARD JAY (MD, DDS)
Entity Type:Individual
Prefix:DR
First Name:HOWARD
Middle Name:JAY
Last Name:SCHNEIDER
Suffix:
Gender:M
Credentials:MD, DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1015 W ADAMS ST
Mailing Address - Street 2:
Mailing Address - City:BOWLING GREEN
Mailing Address - State:MO
Mailing Address - Zip Code:63334-1974
Mailing Address - Country:US
Mailing Address - Phone:573-324-5300
Mailing Address - Fax:573-324-6059
Practice Address - Street 1:1015 W ADAMS ST
Practice Address - Street 2:
Practice Address - City:BOWLING GREEN
Practice Address - State:MO
Practice Address - Zip Code:63334
Practice Address - Country:US
Practice Address - Phone:573-754-4584
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-04
Last Update Date:2018-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0376731223G0001X
MO2010033073207Q00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00785759Medicaid
MO1568664308Medicare UPIN