Provider Demographics
NPI:1821086208
Name:SCHNEIDER, PAUL D (MD)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:D
Last Name:SCHNEIDER
Suffix:
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 1:10510 GRAVELLY LAKE DR SW
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98499-5036
Mailing Address - Country:US
Mailing Address - Phone:253-597-7030
Mailing Address - Fax:253-597-7033
Practice Address - Street 1:10510 GRAVELLY LAKE DR SW
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:WA
Practice Address - Zip Code:98499-5036
Practice Address - Country:US
Practice Address - Phone:253-589-7030
Practice Address - Fax:253-589-7033
Is Sole Proprietor?:No
Enumeration Date:2005-10-11
Last Update Date:2013-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD000015726207R00000X, 207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0065674OtherLABOR AND INDUSTRIES
WA4423SCOtherREGENCE BS SPECIALIST
WA538388831OtherCIGNA
WA0190391OtherOMAC-IME
WA911503824OtherKITSAP HEALTH PLANS
WA215253001OtherGROUP HEALTH WASHINGTON
WA1062991Medicaid
WA911503824OtherTRICARE
WA911503824OtherPACIFICARE WASHINGTON
WA4668902OtherAETHA INSURANCES
WA911503824OtherMOLINA HEALTH CARE
WA911503827OtherPRIVATE HEALTHCARE SYSTEM
WA0180985OtherLABOR & INDUSTRIES IME
WA6611SCOtherREGENCE BS PRIMARY CARE
WA911503827OtherUNITED HEALTHCARE
WA911503827OtherFIRST CHOICE HEALTH PLANS
WA0180985OtherLABOR & INDUSTRIES IME
WA911503824OtherPACIFICARE WASHINGTON
WAAB23221Medicare ID - Type UnspecifiedSECURE HORIZONS WA
WA1062991Medicaid