Provider Demographics
NPI:1669475208
Name:SCHMIDT-NOWARA, WOLFGANG WALTER (MD)
Entity Type:Individual
Prefix:
First Name:WOLFGANG
Middle Name:WALTER
Last Name:SCHMIDT-NOWARA
Suffix:
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 1:4331 BROOKVIEW DR
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75220
Mailing Address - Country:US
Mailing Address - Phone:214-904-0042
Mailing Address - Fax:888-870-8508
Practice Address - Street 1:530A HARKLE RD
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87505-4713
Practice Address - Country:US
Practice Address - Phone:505-983-8512
Practice Address - Fax:888-870-8508
Is Sole Proprietor?:Yes
Enumeration Date:2005-05-27
Last Update Date:2016-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK3847207RS0012X
NM74-235207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX038246701Medicaid
C98083Medicare UPIN
TX80Y782Medicare PIN
80Y782Medicare PIN