Provider Demographics
NPI:1619905916
Name:SCHMIDT, ANTHONY L SR (MD)
Entity Type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:L
Last Name:SCHMIDT
Suffix:SR
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:PO BOX 3109
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39207-3109
Mailing Address - Country:US
Mailing Address - Phone:813-860-4969
Mailing Address - Fax:888-371-7962
Practice Address - Street 1:800 N CAUSEWAY BLVD STE 300
Practice Address - Street 2:
Practice Address - City:MANDEVILLE
Practice Address - State:LA
Practice Address - Zip Code:70448-4664
Practice Address - Country:US
Practice Address - Phone:813-860-4969
Practice Address - Fax:888-371-7962
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-28
Last Update Date:2024-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT042-0016854207ZP0102X
FLME125595207ZP0102X
MS15953207ZH0000X
LAMD207455207ZP0102X
ALMD.37466207ZP0102X
IL036.147410207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
No207ZH0000XAllopathic & Osteopathic PhysiciansPathologyHematology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS0119947Medicaid
MS0119947Medicaid