Provider Demographics
NPI:1851428866
Name:SCHROEDER, JEROME S (MD)
Entity Type:Individual
Prefix:DR
First Name:JEROME
Middle Name:S
Last Name:SCHROEDER
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 1:938 BANNOCK ST
Mailing Address - Street 2:STE 300
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80204-4028
Mailing Address - Country:US
Mailing Address - Phone:303-716-3787
Mailing Address - Fax:303-716-3777
Practice Address - Street 1:938 BANNOCK ST
Practice Address - Street 2:STE 300
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80204-4028
Practice Address - Country:US
Practice Address - Phone:303-716-3787
Practice Address - Fax:303-716-3777
Is Sole Proprietor?:No
Enumeration Date:2007-02-27
Last Update Date:2023-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO405392085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
014867OtherKAISER-COMMERCIAL NUMBER
CO27325024Medicaid
COC496968Medicare PIN
014867OtherKAISER-COMMERCIAL NUMBER
COP00641736Medicare PIN
CO27325024Medicaid
COCO300405Medicare PIN