Provider Demographics
NPI:1720012149
Name:SCHMIDT, ERIC STEPHAN (MD)
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:STEPHAN
Last Name:SCHMIDT
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 1:525 DOYLE PARK DR
Mailing Address - Street 2:SUITE 101
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95405-4516
Mailing Address - Country:US
Mailing Address - Phone:707-544-3584
Mailing Address - Fax:707-544-3251
Practice Address - Street 1:525 DOYLE PARK DR
Practice Address - Street 2:SUITE 101
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95405-4516
Practice Address - Country:US
Practice Address - Phone:707-544-3584
Practice Address - Fax:707-544-3251
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-10
Last Update Date:2013-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG52901207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
00G529010Medicare ID - Type Unspecified
CAF41729Medicare UPIN
00G529012Medicare ID - Type Unspecified
00G529011Medicare ID - Type Unspecified
00G529013Medicare ID - Type Unspecified