Provider Demographics
NPI:1760485676
Name:SCHNEIDER, MARK W (MD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:W
Last Name:SCHNEIDER
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:507 SW BIG BEND TRL
Mailing Address - Street 2:STE J
Mailing Address - City:GLEN ROSE
Mailing Address - State:TX
Mailing Address - Zip Code:76043-4449
Mailing Address - Country:US
Mailing Address - Phone:254-898-0224
Mailing Address - Fax:254-898-0229
Practice Address - Street 1:507 SW BIG BEND TRL
Practice Address - Street 2:STE J
Practice Address - City:GLEN ROSE
Practice Address - State:TX
Practice Address - Zip Code:76043-4449
Practice Address - Country:US
Practice Address - Phone:254-898-0224
Practice Address - Fax:254-898-0229
Is Sole Proprietor?:No
Enumeration Date:2005-05-24
Last Update Date:2012-09-18
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Provider Licenses
StateLicense IDTaxonomies
TXF4491207Q00000X, 207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX017515001Medicaid
TX75-2743893OtherTAX ID
TX752355560OtherTAX ID
TX126287502Medicaid
TX126287521Medicaid
TXTXB156293Medicare PIN
TX86A286Medicare PIN
TXB88091Medicare UPIN
TX080031753Medicare PIN