Provider Demographics
NPI:1790891968
Name:SCHLATER, THEODORE LOUIS III (MD)
Entity Type:Individual
Prefix:DR
First Name:THEODORE
Middle Name:LOUIS
Last Name:SCHLATER
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:126 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BRAWLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92227-2349
Mailing Address - Country:US
Mailing Address - Phone:213-503-8128
Mailing Address - Fax:760-344-3301
Practice Address - Street 1:126 MAIN ST
Practice Address - Street 2:
Practice Address - City:BRAWLEY
Practice Address - State:CA
Practice Address - Zip Code:92227-2349
Practice Address - Country:US
Practice Address - Phone:213-503-8128
Practice Address - Fax:760-344-3301
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG70890208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAF43742Medicare UPIN
CAG70890AMedicare ID - Type Unspecified