Provider Demographics
NPI:1700866886
Name:SCHOMER, STEPHAN J (MD)
Entity Type:Individual
Prefix:
First Name:STEPHAN
Middle Name:J
Last Name:SCHOMER
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 1:444 E POLK ST
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:IA
Mailing Address - Zip Code:52353-1237
Mailing Address - Country:US
Mailing Address - Phone:319-653-6601
Mailing Address - Fax:319-653-5624
Practice Address - Street 1:444 E POLK ST
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:IA
Practice Address - Zip Code:52353-1237
Practice Address - Country:US
Practice Address - Phone:319-653-6601
Practice Address - Fax:319-653-5624
Is Sole Proprietor?:No
Enumeration Date:2006-01-17
Last Update Date:2015-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA26660207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
060036494OtherRR MEDICARE
IA1050336Medicaid
CA3899OtherRR MEDICARE GROUP
71960OtherMEDICARE GROUP
54383OtherWELLMARK
A03736Medicare UPIN
IA1050336Medicaid