Provider Demographics
NPI:1730289299
Name:SCHNEIDER, CHARLES E (DPM)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:E
Last Name:SCHNEIDER
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1619 N GREENWOOD ST
Mailing Address - Street 2:# 300
Mailing Address - City:PUEBLO
Mailing Address - State:CO
Mailing Address - Zip Code:81003-2644
Mailing Address - Country:US
Mailing Address - Phone:719-543-2476
Mailing Address - Fax:719-543-2479
Practice Address - Street 1:1619 N GREENWOOD ST
Practice Address - Street 2:#300
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81003-2644
Practice Address - Country:US
Practice Address - Phone:719-543-2476
Practice Address - Fax:719-543-2479
Is Sole Proprietor?:No
Enumeration Date:2006-09-25
Last Update Date:2008-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO282213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO04012167Medicaid
R5324OtherBC
840828115001OtherRKY MT HEALTH PLAN
COCF5923Medicare ID - Type Unspecified
R5324OtherBC