Provider Demographics
NPI:1740211424
Name:SCHOONOVER-EGOLF, JEAN A (MD)
Entity Type:Individual
Prefix:MRS
First Name:JEAN
Middle Name:A
Last Name:SCHOONOVER-EGOLF
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:JEAN
Other - Middle Name:ANN
Other - Last Name:SCHOONOVER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:11826 GALLIA PIKE SUITE A
Mailing Address - Street 2:
Mailing Address - City:WHEELERSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:45694
Mailing Address - Country:US
Mailing Address - Phone:740-574-0600
Mailing Address - Fax:740-574-2895
Practice Address - Street 1:11826 GALLIA PIKE SUITE A
Practice Address - Street 2:
Practice Address - City:WHEELERSBURG
Practice Address - State:OH
Practice Address - Zip Code:45694
Practice Address - Country:US
Practice Address - Phone:740-574-0600
Practice Address - Fax:740-574-2895
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2008-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35084458207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
0409576OtherUNITED HEALTHCARE
OH2540423Medicaid
OHPD0139394OtherRAILROAD MEDICARE
000000337846OtherBLUE CROSS BLUE SHIELD
000000337846OtherBLUE CROSS BLUE SHIELD
OH2540423Medicaid