Provider Demographics
NPI:1710905849
Name:SCHMITZ, STEPHEN PAUL (PHD)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:PAUL
Last Name:SCHMITZ
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2523 BROADWAY
Mailing Address - Street 2:SUITE 200
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80304-4240
Mailing Address - Country:US
Mailing Address - Phone:303-938-9244
Mailing Address - Fax:303-413-1308
Practice Address - Street 1:2523 BROADWAY
Practice Address - Street 2:SUITE 200
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80304-4240
Practice Address - Country:US
Practice Address - Phone:303-938-9244
Practice Address - Fax:303-413-1308
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2015-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1242174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
COC809744Medicare PIN