Provider Demographics
NPI:1619957842
Name:SCHMIDT, DANIEL LEE (DO)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:LEE
Last Name:SCHMIDT
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:P.O. BOX 2275
Mailing Address - Street 2:242 ENCHANTED RIVER ESTATES
Mailing Address - City:BANDERA
Mailing Address - State:TX
Mailing Address - Zip Code:78003
Mailing Address - Country:US
Mailing Address - Phone:210-827-6536
Mailing Address - Fax:830-334-2618
Practice Address - Street 1:242 ENCHANGED RIVER ESTATES
Practice Address - Street 2:
Practice Address - City:BANDERA
Practice Address - State:TX
Practice Address - Zip Code:78003
Practice Address - Country:US
Practice Address - Phone:210-827-6536
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-23
Last Update Date:2015-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UTLTXBE5926207Q00000X
TXE-5926207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX137833305Medicaid
TX137833305Medicaid
TX00AN44Medicare PIN