Provider Demographics
NPI:1578824710
Name:SCHMIDT, MARY MELISSA (DO)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:MELISSA
Last Name:SCHMIDT
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3924 ORTEGA BLVD
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32210-4418
Mailing Address - Country:US
Mailing Address - Phone:904-708-3197
Mailing Address - Fax:
Practice Address - Street 1:3924 ORTEGA BLVD
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32210-4418
Practice Address - Country:US
Practice Address - Phone:215-756-5114
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-05
Last Update Date:2023-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI61783207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI100080754Medicaid