Provider Demographics
NPI:1750670147
Name:SCHMIDT, JEFF ROBERT
Entity Type:Individual
Prefix:
First Name:JEFF
Middle Name:ROBERT
Last Name:SCHMIDT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21710 MIXON RD
Mailing Address - Street 2:
Mailing Address - City:TROUP
Mailing Address - State:TX
Mailing Address - Zip Code:75789-5758
Mailing Address - Country:US
Mailing Address - Phone:903-830-5021
Mailing Address - Fax:
Practice Address - Street 1:21710 MIXON RD
Practice Address - Street 2:
Practice Address - City:TROUP
Practice Address - State:TX
Practice Address - Zip Code:75789-5758
Practice Address - Country:US
Practice Address - Phone:903-830-5021
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-06
Last Update Date:2011-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor