Provider Demographics
NPI:1598739641
Name:SCHMIEDER, MARY ELIZABETH (DO, FACEP,INC)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:ELIZABETH
Last Name:SCHMIEDER
Suffix:
Gender:F
Credentials:DO, FACEP,INC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1543 KINGSLEY AVE
Mailing Address - Street 2:BUILDING 16
Mailing Address - City:ORANGE PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32073-4535
Mailing Address - Country:US
Mailing Address - Phone:904-278-2246
Mailing Address - Fax:904-278-2247
Practice Address - Street 1:1543 KINGSLEY AVE
Practice Address - Street 2:BUILDING 16
Practice Address - City:ORANGE PARK
Practice Address - State:FL
Practice Address - Zip Code:32073-4535
Practice Address - Country:US
Practice Address - Phone:904-278-2246
Practice Address - Fax:904-278-2247
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-15
Last Update Date:2010-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS0004991207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL82832TMedicare ID - Type Unspecified
FLD60741Medicare UPIN