Provider Demographics
NPI:1659548113
Name:SCHNEIDER, JOHN MATTHEW (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:MATTHEW
Last Name:SCHNEIDER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:2005 LONG KNIFE CT
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40207-1176
Mailing Address - Country:US
Mailing Address - Phone:502-386-5604
Mailing Address - Fax:000-000-0000
Practice Address - Street 1:2005 LONG KNIFE CT
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40207
Practice Address - Country:US
Practice Address - Phone:502-386-5604
Practice Address - Fax:000-000-0000
Is Sole Proprietor?:No
Enumeration Date:2008-05-14
Last Update Date:2018-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY45412207L00000X, 207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201118210AMedicaid
KY7100202490Medicaid
KYP01155307OtherMEDICARE RAILROAD