Provider Demographics
NPI:1740218353
Name:SCHWARTZ, C. BRUCE (MD)
Entity Type:Individual
Prefix:
First Name:C.
Middle Name:BRUCE
Last Name:SCHWARTZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:CARL
Other - Middle Name:BRUCE
Other - Last Name:SCHWARTZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 1520
Mailing Address - Street 2:
Mailing Address - City:THE DALLES
Mailing Address - State:OR
Mailing Address - Zip Code:97058
Mailing Address - Country:US
Mailing Address - Phone:541-296-7668
Mailing Address - Fax:541-296-6431
Practice Address - Street 1:551 LONE PINE BLVD
Practice Address - Street 2:
Practice Address - City:THE DALLES
Practice Address - State:OR
Practice Address - Zip Code:97058
Practice Address - Country:US
Practice Address - Phone:541-506-6500
Practice Address - Fax:541-296-6431
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2011-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK3570207X00000X
ORMD08596207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKMD2341Medicaid
WA146162OtherWASHING L&I
OR292179Medicaid
200027807OtherMEDICARE RAILROAD
ORR156925Medicare PIN
AKMD2341Medicaid
AKK020ZBBBLEMedicare PIN