Provider Demographics
NPI:1760586200
Name:SCHNEIDER, JEFFREY ROBERT (DPM)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:ROBERT
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 1:120 S LOCUST ST
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:AL
Mailing Address - Zip Code:35630-5510
Mailing Address - Country:US
Mailing Address - Phone:256-764-2855
Mailing Address - Fax:256-767-5242
Practice Address - Street 1:120 S LOCUST ST
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:AL
Practice Address - Zip Code:35630-5510
Practice Address - Country:US
Practice Address - Phone:256-764-2855
Practice Address - Fax:256-767-5242
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-12
Last Update Date:2009-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL0065213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALT68900Medicare UPIN
AL1158180001Medicare NSC