Provider Demographics
NPI:1710077631
Name:SCHMIDT, SABRINA J (MD)
Entity Type:Individual
Prefix:DR
First Name:SABRINA
Middle Name:J
Last Name:SCHMIDT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:SABRINA
Other - Middle Name:J
Other - Last Name:FROST
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 6210
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:NM
Mailing Address - Zip Code:87499-6210
Mailing Address - Country:US
Mailing Address - Phone:505-609-2258
Mailing Address - Fax:505-609-2259
Practice Address - Street 1:4820 E MAIN ST
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:NM
Practice Address - Zip Code:87402-8660
Practice Address - Country:US
Practice Address - Phone:505-609-6495
Practice Address - Fax:505-609-2259
Is Sole Proprietor?:No
Enumeration Date:2006-10-13
Last Update Date:2013-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2002007111207Q00000X
NMMD2013-0759207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO199031OtherBCMO
MO200212926Medicaid
933900038Medicare PIN
G60737Medicare UPIN
MO200212926Medicaid